Purpose

Subretinal Hyper-reflective Material(SHRM) is the term used for hyper-reflective area seen usually in choroidal neovascular membranes(CNV) in Age related macular degeneration and may comprise fibrosis, abnormal new vessels or both.In Posterior Uveitis,SHRM could represent scar secondary to inflammation or an underlying CNV that may require anti-VEGF therapy.The present study aims to describe the characteristics of SHRM using Swept-Source Optical Coherence Tomography(SS-OCT) and SS-OCT Angiography and study the role of anti-VEGF therapy in eyes with vascular SHRM.

Methods

In a prospective randomized control study,SS-OCT and SS-OCTA were used to study SHRM characteristics and identify CNV complex within SHRM.Eyes with vascular SHRM were randomised to receive treatment(Group I) with intravitreal Ranibizumab (0.05mg/0.05ml) versus observation(group II).Change in SHRM dimensions,character and flow from baseline were studied in both the groups at 6 month follow up.

Results

Forty-two eyes of 33 subjects(18 males; mean age: 29.52 ± 12.56 years) were evaluated.Two-third (28/42) of the eyes with SHRM harboured CNV(Vascular SHRM) at presentation.13/28 eyes with vascular SHRM received treatment.High reflectivity (p<0.001) and increased OCT transmission through SHRM(p=0.03) suggest avascular SHRM.Presence of Pitchfork sign(p=0.017) and Intra/subretinal fluid(p=0.08) indicate presence of intrinsic CNV.Upon follow-up, significant decrease in SHRM parameters(p<0.05) and improvement in BCVA(p<0.05) was observed in treatment group as compared to the observation group.

Conclusions

Meticulous assessment of SHRM characteristics on SS-OCT can aid in identifying underling intrinsic neovascular network.SHRM also acts as a useful biomarker to monitor activity and response to therapy in eyes with CNV.