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Title: Subretinal Hyperreflective Material Imaged With Optical Coherence Tomography Angiography
Authors: 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
Vitreous Retina Macula Consultants of New York
Manhattan Eye, Ear and Throat Hospital
University of Nebraska Medical Center
Moorfields Eye Hospital NHS Foundation Trust
Singapore Eye Research Institute
University of California, Los Angeles
Mahidol University
Tufts University School of Medicine
Universidade Federal de Sao Paulo
Universita Vita-Salute San Raffaele
NYU School of Medicine
VA Medical Center
Keywords: Medicine
Issue Date: 1-Sep-2016
Citation: American Journal of Ophthalmology. Vol.169, (2016), 235-248
Abstract: © 2016 Elsevier Inc. 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.
ISSN: 18791891
Appears in Collections:Scopus 2016-2017

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