Subretinal Hyperreflective Material Imaged With Optical Coherence Tomography Angiography

Kunal K Dansingani; Anna C S Tan; Fatimah Gilani; Nopasak Phasukkijwatana; Eduardo Novais; Lea Querques; Nadia K Waheed; Jay S Duker; Giuseppe Querques; Lawrence A Yannuzzi; David Sarraf; K Bailey Freund

doi:10.1016/j.ajo.2016.06.031

Subretinal Hyperreflective Material Imaged With Optical Coherence Tomography Angiography

Am J Ophthalmol. 2016 Sep:169:235-248. doi: 10.1016/j.ajo.2016.06.031. Epub 2016 Jun 25.

Authors

Affiliations

¹ Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska; Moorfields Eye Hospital, London, United Kingdom.
² Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; Singapore National Eye Center, Singapore Eye Research Institute, Singapore.
³ Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York.
⁴ Stein Eye Institute, University of California, Los Angeles, Los Angeles, California; Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
⁵ New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts; Federal University of São Paulo, School of Medicine, São Paulo, Brazil.
⁶ University Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
⁷ New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts.
⁸ Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York.
⁹ Stein Eye Institute, University of California, Los Angeles, Los Angeles, California; Greater Los Angeles VA Healthcare Center, Los Angeles, California.
¹⁰ Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York. Electronic address: kbfnyf@aol.com.

PMID: 27349411
DOI: 10.1016/j.ajo.2016.06.031

Abstract

Purpose: The range of subretinal hyperreflective material (SHRM) seen in macular disease includes type 2 macular neovascularization, fibrosis, exudation, vitelliform material, and hemorrhage. The prognostic significance of SHRM has been evaluated retrospectively in clinical trials, but discriminating SHRM subtypes traditionally requires multiple imaging modalities. The purpose of this study is to describe optical coherence tomography angiography (OCTA) flow characteristics and artifacts that might help to distinguish SHRM subtypes.

Design: Validity analysis.

Methods: Patients with age-related macular degeneration (AMD), myopia, pachychoroid disease, and macular dystrophy, manifesting SHRM on optical coherence tomography (OCT), were recruited. Clinical chart review and multimodal imaging established the SHRM subtype. All patients underwent OCTA. OCT and OCTA images were examined together for (1) intrinsic flow, (2) retinal projection onto the anterior SHRM surface (strong, weak, absent), (3) retinal projection through SHRM onto retinal pigment epithelium (RPE), and (4) masking of choriocapillaris flow.

Results: Thirty-three eyes of 25 patients were included (type 2 neovascularization ×3; fibrosis ×4; exudation ×10; hemorrhage ×5; vitelliform ×17). Mean age per eye was 76 years (standard deviation: 12). Intrinsic flow was strongest in type 2 neovascularization. Subretinal fibrosis showed limited flow in residual large-caliber vessels and branches. Flow was not detected within foci of exudation, hemorrhage, or vitelliform lesions. Retina-SHRM surface projection was strongest onto smooth-surfaced SHRM and weaker onto exudation. Retinal projection was weakest on the surface of vitelliform lesions. Retina-RPE projection was masked by dense hemorrhage and vitelliform material. In compound SHRM, OCTA distinguished between vascular and avascular components.

Conclusion: Optical coherence tomography angiography can distinguish vascular from avascular SHRM components. OCTA artifacts may distinguish certain avascular SHRM components.

Publication types

Validation Study

MeSH terms

Aged
Aged, 80 and over
Choroid Diseases / diagnosis
Exudates and Transudates
Female
Fibrosis / diagnosis
Fluorescein Angiography*
Humans
Lipofuscin / metabolism
Macular Degeneration / diagnosis
Male
Middle Aged
Multimodal Imaging
Myopia / diagnosis
Retinal Drusen / diagnosis*
Retinal Hemorrhage / diagnosis*
Tomography, Optical Coherence*
Vitelliform Macular Dystrophy / diagnosis*
Vitelliform Macular Dystrophy / metabolism
Wet Macular Degeneration / diagnosis*

Substances

Lipofuscin