Characteristics and Response of Subretinal Hyperreflective Material to Anti-vascular Endothelial Growth Factor in Myopic Choroidal Neovascularization

Abstract

Abstract This retrospective study evaluated the characteristics and response of subretinal hyperreflective material (SHRM) to anti-vascular endothelial growth factor (VEGF) treatment in eyes with myopic choroidal neovascularization (CNV). The visual acuity (VA) was assessed at 3, 6, and 12 months after initiating anti-VEGF treatment in 116 patients (119 eyes) with SHRM and myopic CNV. Multimodal imaging, including color fundus photography, fluorescein angiography (FA), and optical coherence tomography angiography (OCT-A), were performed. We compared type 2 neovascularization (NV) (n=64), subretinal hyperreflective exudation (SHE) (n=37), NV with hemorrhage (n=15), and fibrosis (n=3). The type 2 NV and NV with hemorrhage groups showed significant VA improvement after 12 months of treatment; the SHE group failed to show improvement (p<0.05, p<0.05, and p=0.366, respectively). All groups showed a significant reduction in central foveal thickness after 12 months of treatment (all p<0.05). The SHE group had a significantly higher incidence of interrupted ellipsoid zone than the other groups (p<0.05). Myopic CNV can present as SHRM on OCT-A. Visual prognoses vary in different SHRM types. OCT-A and FA may help predict the outcomes of different subtypes of myopic CNV. SHE is predictive of outer retinal layer atrophy in patients with various SHRM types.