Association Between Subretinal Hyperreflective Material and OCTA-Derived Macular Neovascularization Morphology in Treatment-Naive Neovascular Age-Related Macular Degeneration.

Purpose

To evaluate whether baseline subretinal hyperreflective material (SHRM) status is associated with optical coherence tomography angiography (OCTA)-derived macular neovascularization (MNV) vessel density, complexity, and ramification in treatment-naive neovascular age-related macular degeneration (nAMD).

Methods

This retrospective, single-center, cross-sectional imaging study included 89 eyes from 89 treatment-naive patients with nAMD. One eye per patient was included to avoid inter-eye correlation. SHRM was assessed on baseline structural optical coherence tomography (OCT). OCTA images were acquired using 6 × 6 mm scans, and MNV lesions were manually delineated as regions of interest. The primary OCTA-derived parameters were MNV vessel density, fractal dimension, and branch points. Multivariable linear regression models were adjusted for age, sex, central macular thickness, and MNV type.

Results

SHRM was present in 56 eyes (62.9%) and absent in 33 eyes (37.1%). Compared with SHRM-negative eyes, SHRM-positive eyes had worse baseline best-corrected visual acuity (BCVA) (P < 0.001), greater central macular thickness (P < 0.001), and higher frequencies of subretinal fluid, intraretinal fluid, and retinal hemorrhage. SHRM-positive eyes also showed higher MNV vessel density (0.262 vs. 0.196; P = 0.017), fractal dimension (1.568 vs. 1.487; P = 0.024), and branch points (140.5 vs. 91.0; P = 0.035). After adjustment, SHRM remained associated with higher MNV vessel density (β = 0.045; P = 0.042), fractal dimension (β = 0.077; P = 0.029), and branch points (β = 98.74; P = 0.045).

Conclusions

These findings suggest that SHRM-positive status is associated with a denser, more complex, and more ramified OCTA-derived MNV vascular phenotype at baseline in treatment-naive nAMD.