We enrolled 119 eyes of 116 patients with myopic CNV and SHRM on OCT. These patients were followed up for at least 12 months. The baseline characteristics are shown in Table 1.
Table 1
Baseline characteristics of all study eyes
Total Eyes | 119 | |
Right (%) | 55 (46.2) | |
Left (%) | 64 (53.8) | |
Number of patients | 114 | |
Men (%) | 31 (27.2) | |
Women (%) | 83 (72.8) | |
Age, mean ± SD, years (range) | 60.4 ± 12.1 (33–94) | |
Component of SHRM | | |
Type 2 Neovascularization (%) | 64 (53.8%) | |
Fibrosis (%) | 3 (2.5%) | |
Subretinal hyperreflective exudation (%) | 37 (31.1%) | |
Haemorrhage (%) | 15 (12.6%) | |
Axial length, mean ± SD, mm (range) | 29.57 ± 1.63 (33.72–26.69) | |
Anti-VEGF used (Eyela/Lucentis) | 12/107 | |
SD, standard deviation; SHRM, subretinal hyperreflective material; VEGF, vascular endothelial growth factor |
Among the 119 included eyes, 55 were right eyes, and 64 were left eyes. Among the 116 included patients, 31 were men, and 83 were women. The age of these patients ranged from 33 to 94 years (mean age 60.4 ± 12.1 years). In terms of SHRM type, there were 64 cases of type 2 NV, 37 cases of SHE, 15 cases of hemorrhage, and three cases of fibrosis. The morphological pictures were demonstrated in Fig. 1.
The criteria used to classify SHRM were based on those used in previous studies.[25] The characteristics of the different SHRM groups are summarized in Table 2.
Table 2
Differences in the characteristics of the eyes according to the SHRM components
SHRM component | Type 2 NV | Fibrosis | SHE | Haemorrhage |
Number of eyes | 64 | 3 | 37 | 15 |
Sex, male (%) | 20 (31.3) | 2 (66.7) | 6 (16.2) | 6 (40.0) |
Age, years (mean ± SD) | 60.4 ± 11.5 | 57.3 ± 14.5 | 61.6 ± 10.6 | 57.6 ± 14.2 |
logMAR visual acuity at baseline (mean ± SD) | 0.74 ± 0.45 | 1.23 ± 0.21 | 0.80 ± 0.34 | 0.80 ± 0.32 |
Mean central foveal thickness at baseline (µm, mean ± SD) | 295.30 ± 79.91 | 237.33 ± 27.79 | 291.32 ± 67.32 | 350.73 ± 114.66 |
Axial length (mm, mean ± SD) | 29.7 ± 1.7 | 28.47 ± 2.4 | 29.7 ± 1.8 | 29.0 ± 1.0 |
Presence/absence of SHRM at 12 months | 54/10 (84.4%) | 3/0 (100%) | 30/7 (81.1%) | 12/3 (80.0%) |
Disrupted/intact ellipsoid zone at 12 months | 27/37 (42.2%) | 3/0 (100%) | 25/12 (67.6%) | 7/8 (46.7%) |
Presence/absence of IRF or SRF at 12 months | 6/58 (9.4%) | 0/3 (0%) | 4/33 (10.8%) | 4/11 (26.7%) |
Presence/absence of atrophy | 8/56 (12.5%) | 3/0 (100%) | 8/29 (21.6%) | 1/14 (6.7%) |
Number of injections (mean ± SD) | 2.54 ± 1.15 | 2 | 2.60 ± 1.06 | 2.60 ± 0.91 |
SHRM, subretinal hyperreflective material; SD, standard deviation; IRF, intra-retinal fluid; SRF, subretinal fluid; NV, neovascularization; SHE, subretinal hyperreflective exudation |
The baseline characteristics, including age, sex, axial length, and the number of injections in 1 year, were comparable among the four groups. However, the fibrosis group had a significantly poorer baseline VA, and the hemorrhage group had a higher CFT than the other groups.
The mean logMAR VA at baseline was 0.74 ± 0.45, 1.23 ± 0.21, 0.80 ± 0.34, and 0.80 ± 0.32 in the type 2 NV, fibrosis, SHE, and hemorrhage groups, respectively. All patients received anti-VEGF treatment, and further treatment was administered if SRF or IRF persisted. The mean logMAR VA at 3, 6, and 12 months were 0.63 ± 0.57, 0.62 ± 0.55, and 0.60 ± 0.57, respectively, in the type 2 NV group; 0.78 ± 0.44, 0.83 ± 0.55, and 0.82 ± 0.55, respectively, in the SHE group; and 0.52 ± 0.51, 0.53 ± 0.51, and 0.46 ± 0.46, respectively, in the hemorrhage group. At 3, 6, and 12 months, VA in patients with type 2 NV and hemorrhage improved significantly from the baseline VA (p < 0.05) (Table 3).
Table 3
Visual acuity and central foveal thickness according to the SHRM components
| Type 2 NV | SHE | Haemorrhage |
LogMAR visual acuity at baseline (mean ± SD) | 0.74 ± 0.45 | 0.80 ± 0.34 | 0.80 ± 0.32 |
LogMAR visual acuity at 3 months (mean ± SD) | 0.63 ± 0.57* | 0.78 ± 0.44 | 0.52 ± 0.51* |
LogMAR visual acuity at 6 months (mean ± SD) | 0.62 ± 0.55* | 0.83 ± 0.55 | 0.53 ± 0.51* |
LogMAR visual acuity at 12 months (mean ± SD) | 0.60 ± 0.57* | 0.82 ± 0.55 | 0.46 ± 0.46* |
Mean central foveal thickness at baseline (µm, mean ± SD) | 295.29 ± 79.91 | 291.3 ± 67.32 | 350.73 ± 114.67 |
Mean central foveal thickness at 3 months (µm, mean ± SD) | 260.54 ± 59.20* | 239.85 ± 61.35* | 266.93 ± 44.14* |
Mean central foveal thickness at 6 months (µm, mean ± SD) | 254.97 ± 43.91* | 233.51 ± 38.43* | 259.13 ± 44.46* |
Mean central foveal thickness at 12 months (µm, mean ± SD) | 252.52 ± 50.87* | 227.11 ± 32.76* | 268.47 ± 50.08* |
* compared with baseline: p < 0.05 |
SHRM, subretinal hyperreflective material; SD, standard deviation; NV, neovascularization; SHE, subretinal hyperreflective exudation |
However, VA failed to improve significantly at 3, 6, and 12 months in patients with SHE (Fig. 2). The VA at baseline was not significantly different among type 2 NV, SHE, and hemorrhage groups. However, after treatment for 3 months, the hemorrhage group showed a significantly better logMAR VA than the SHE group (p < 0.05). Moreover, after treatment for 6 and 12 months, the type 2 NV and hemorrhage groups showed significantly better logMAR VA than the SHE group (p < 0.05) (Fig. 3).
The mean CFT at baseline was 295.29 ± 79.91 µm, 291.3 ± 67.32 µm, and 350.73 ± 114.67 µm in the type 2 NV, SHE, and hemorrhage groups, respectively. During the follow-up at 3, 6, and 12 months, the mean CFT was 260.54 ± 59.20 µm, 254.97 ± 43.91 µm, and 252.52 ± 50.87 µm, respectively, in the type 2 NV group; 239.85 ± 61.35 µm, 233.51 ± 38.43 µm, and 227.11 ± 32.76 µm, respectively, in the SHE group; and 266.93 ± 44.14 µm, 259.13 ± 44.46 µm, and 268.47 ± 50.08 µm, respectively, in the hemorrhage group. During follow-up at 3, 6, and 12 months, CFT in the type 2 NV, SHE, and hemorrhage groups all showed a significant reduction compared with the baseline values (p < 0.05) (Fig. 4).
In terms of the OCT morphological features in the different SHRM groups (Table 4), there were no differences in the resolution of SHRM, presence or absence of IRF or SRF, and presence of atrophy at 12 months. The SHE group had a higher proportion of patients with interrupted ellipsoid zone at 12 months than the type 2 NV group (p < 0.05) (Fig. 5).
Table 4
OCT morphological features in different SHRM groups
p-value | Presence of SHRM at 12M | Interrupted ellipsoid zone at 12M | Presence of IRF or SRF at 12M | Presence of atrophy at 12M |
Type 2 NV, SHE, haemorrhage | 0.873 | 0.045* | 0.173 | 0.295 |
Type 2 NV vs. SHE | 0.670 | 0.013* | 0.816 | 0.226 |
Type 2 NV vs. haemorrhage | 0.680 | 0.752 | 0.070 | 0.522 |
SHE vs. haemorrhage | 0.929 | 0.160 | 0.151 | 0.196 |
* compared with baseline: p < 0.05 |
OCT, optical coherence tomography; NV, neovascularization; SHE, subretinal hyperreflective exudation; SHRM, subretinal hyperreflective material; M, month; IRF, intra-retinal fluid; SRF, subretinal fluid |
Further analysis of the atrophy and non-atrophy subgroups at 12 months after treatment revealed that older age and poor VA at baseline were associated with a significantly higher risk of atrophy after 12 months of treatment. Other factors, including sex, axial length, mean CFT at baseline, anti-VEGF use, or the number of injections, failed to show significant differences between the atrophy and non-atrophy groups (Table 5).
Table 5
Characteristics of the atrophy and non-atrophy groups
| Atrophy | Non-atrophy | p-value |
Age (years, mean ± SD) | 65.52 ± 12.06 | 59.12 ± 11.43 | 0.014* |
Sex (%, male/female) | 0.421 | 0.253 | 0.069 |
Axial length (mm, mean ± SD) | 29.74 ± 1.90 | 29.54 ± 1.55 | 0.348 |
LogMAR visual acuity at baseline (mean ± SD) | 1.023 ± 0.329 | 0.723 ± 0.384 | 0.001* |
Mean central foveal thickness at baseline (µm, mean ± SD) | 315.42 ± 120.36 | 299.57 ± 73.43 | 0.224 |
Anti-VEGF used (%, Eyela/Lucentis) | 0.105 | 0.105 | 0.500 |
Number of injections (mean ± SD) | 2.58 ± 0.84 | 2.55 ± 1.12 | 0.453 |
* compared with baseline: p < 0.05 |
SD, standard deviation; VEGF, vascular endothelial growth factor |