J Korean Ophthalmol Soc.  2015 Aug;56(8):1188-1194. 10.3341/jkos.2015.56.8.1188.

Correlation between Visual Outcomes and Pre-Treatment Factors Including Hyperreflective Foci in Neovascular Age-Related Macular Degeneration

• Lee HW
• Kim HC

• KMID: 2215069
• DOI: http://doi.org/10.3341/jkos.2015.56.8.1188

Abstract

PURPOSE
To investigate the correlation between hyperreflective foci (HF) on spectral domain optical coherence tomography (SD-OCT) at baseline and visual outcomes after intravitreal ranibizumab injection in neovascular age-related macular degeneration (nAMD).
METHODS
We retrospectively reviewed the medical records of 44 eyes of 44 nAMD patients. The number of HF was counted according to the location of HF on SD-OCT: neurosensory retinal layer, outer retinal layer, and subretinal layer. Statistical correlations among final visual acuity (VA) and pretreatment OCT parameters including number of HF, foveal thickness (FT), thickness of choroidal neovascularization (CNV), the status of external limiting membrane, and photoreceptor inner and outer segments (IS/OS) were evaluated.
RESULTS
The number of HF was reduced in all retinal layers in nAMD patients after treatment. In multivariate regression analysis, final VA was associated with baseline VA, number of subretinal HF, and IS/OS disruption length (p = 0.028, p = 0.046 and p = 0.009, respectively) in nAMD patients. The baseline number of subretinal HF was correlated with final FT and CNV thickness (p = 0.002 and p = 0.009, respectively).
CONCLUSIONS
The baseline number of subretinal HF on SD-OCT might predict the final VA after intravitreal ranibizumab treatment in nAMD patients.

Keyword

Hyperreflective foci; Neovascular age-related macular degeneration; Ranibizumab; Spectral domain optical coherence tomography; Visual outcome

MeSH Terms

Choroidal Neovascularization
Humans
Macular Degeneration*
Medical Records
Membranes
Retinaldehyde
Retrospective Studies
Tomography, Optical Coherence
Visual Acuity
Ranibizumab
Retinaldehyde

Figure

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  Figure 1. A 66-year-old male presented with neovascular age- related macular degeneration. (A) Fundus photography at ini-tial visit. Serous elevation is seen at the macula and yellowish fibrinous materials are seen at the parafoveal area. The visual acuity is 20/100. (B) Fundus photography at final visit. Serous elevation is resolved and yellowish fibrinous materials are much decreased. The visual acuity is 20/50. (C) Initial fluo-rescein angiography shows diffuse leakage around macula. (D) Initial indocyanine green angiography shows no definite polypoidal lesions. (E) Horizontal sectional image of optical coherence tomography (OCT) images at initial visit. The OCT shows sparse hyperreflective foci (red arrows) distribution in the inner, outer, and subretinal layers. Subretinal hyper-reflective foci are aggregated at the roof of the subretinal fluid (SRF). (F) Horizontal sectional image of OCT at final visit. Hyperreflective foci are almost resolved and just small amounts (red arrows) of hyperreflective foci remain at the in-ner retinal layer. SRF is also resolved.

• 

  Figure 2. A 76-year-old male presented with neovascular age- related macular degeneration. (A) Fundus photography at ini-tial visit. Serous elevation at the macula is observed. Baseline visual acuity was 20/60. (B) Fundus photography at final visit. Serous elevation is decreased. (C) Initial fluorescein angiog-raphy shows multiple hyperfluorescene lesions around macula. (D) Initial indocyanine green angiography shows no definite polypoidal lesions. (E) Horizontal sectional image of spectral domain optical coherence tomography (SD-OCT) im-ages at initial visit. The image shows sparse hyperreflective foci (red arrows) distribution at all retinal layers, especially at the subretinal layer. (F) Horizontal sectional image of SD-OCT at final visit. Hyperreflective foci are reduced, but still present around the outer and subretinal layers (red ar-rows). Subretinal fluid has also resolved.

Reference

References

1. Seddon JM, Chen CA. The epidemiology of age-related macular degeneration. Int Ophthalmol Clin. 2004; 44:17–39.

2. Youm DJ, Oh HS, Yu HG, Song SJ. The prevalence of vitreoretinal diseases in a screened Korean population 50 years and older. J Korean Ophthalmol Soc. 2009; 50:1645–51.

3. Klein R, Klein BE, Knudtson MD. . Fifteen-year cumulative incidence of age-related macular degeneration; the beaver dam eye study. Ophthalmology. 2007; 114:253–62.

4. Lim LS, Mitchell P, Seddon JM. . Age-related macular degeneration. Lancet. 2012; 379:1728–38.

5. Chen TC, Cense B, Pierce MC. . Spectral domain optical co-herence tomography: ultra-high speed, ultra-high resolution oph-thalmic imaging. Arch Ophthalmol. 2005; 123:1715–20.

6. Bolz M, Schmidt-Erfurth U, Deak G. . Optical coherence to-mographic hyperreflective foci: a morphologic sign of lipid ex-travasation in diabetic macular edema. Ophthalmology. 2009; 116:914–20.

7. Ogino K, Murakami T, Tsujikawa A. . Characteristics of opti-cal coherence tomographic hyperreflective foci in retinal vein occlusion. Retina. 2012; 32:77–85.

8. Kang JW, Lee H, Chung H, Kim HC. Correlation between optical coherence tomographic hyperreflective foci and visual outcomes after intravitreal bevacizumab for macular edema in branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol. 2014; 252:1413–21.

9. Framme C, Wolf S, Wolf-Schnurrbusch U. Small dense particles in the retina observable by spectral-domain optical coherence tomog-raphy in age-related macular degeneration. Invest Ophthalmol Vis Sci. 2010; 51:5965–9.

10. Akagi-Kurashige Y, Tsujikawa A, Oishi A. . Relationship be-tween retinal morphological findings and visual function in age-re-lated macular degeneration. Graefes Arch Clin Exp Ophthalmol. 2012; 250:1129–36.

11. Coscas G, De Benedetto U, Coscas F. . Hyperreflective dots: a new spectral-domain optical coherence tomography entity for fol-low-up and prognosis in exudative age-related macular degeneration. Ophthalmologica. 2013; 229:32–7.

12. Uji A, Murakami T, Nishijima K. . Association between hyper-reflective foci in the outer retina, status of photoreceptor layer, and visual acuity in diabetic macular edema. Am J Ophthalmol. 2012; 153:710–7.

13. Schuman SG, Koreishi AF, Farsiu S. . Photoreceptor layer thinning over drusen in eyes with age-related macular degeneration imaged in vivo with spectral-domain optical coherence tomography. Ophthalmology. 2009; 116:488–96.

14. Laude A, Cackett PD, Vithana EN. . Polypoidal choroidal vas-culopathy and neovascular age-related macular degeneration: same or different disease? Prog Retin Eye Res. 2010; 29:19–29.

15. Gomi F, Ohji M, Sayanagi K. . One-year outcomes of photo-dynamic therapy in age-related macular degeneration and poly-poidal choroidal vasculopathy in Japanese patients. Ophthalmology. 2008; 115:141–6.

16. Ota M, Nishijima K, Sakamoto A. . Optical coherence tomo-graphic evaluation of foveal hard exudates in patients with diabetic maculopathy accompanying macular detachment. Ophthalmology. 2010; 117:1996–2002.

17. Ciardella AP, Donsoff IM, Huang SJ. . Polypoidal choroidal vasculopathy. Surv Opthalmol. 2004; 49:25–37.

18. Simader C, Ritter M, Bolz M. . Morphologic parameters rele-vant for visual outcome during anti-angiogenic therapy of neo-vascular age-related macular degeneration. Ophthalmology. 2014; 121:1237–45.

19. Kim YM, Kim JH, Koh HJ. Improvement of photoreceptor in-tegrity and associated visual outcome in neovascular age-related macular degeneration. Am J Ophthalmol. 2012; 154:164–73.

20. Oishi A, Hata M, Shimozono M. . The significance of external limiting membrane status for visual acuity in age-related macular degeneration. Am J Ophthalmol. 2010; 150:27–32.

21. Ho J, Witkin AJ, Liu J. . Documentation of intraretinal retinal pigment epithelium migration via high-speed ultrahigh-resolution optical coherence tomography. Ophthalmology. 2011; 118:687–93.

22. Pieroni CG, Witkin AJ, Ko TH. . Ultrahigh resolution optical coherence tomography in non-exudative age related macular degeneration. Br J Ophthalmol. 2006; 90:191–7.