Hyperreflective material evolution patterns during long term anti-VEGF therapy in neovascular age-related macular degeneration

This retrospective, real-life cohort was analyzed to detect the frequency of different HRM evolution patterns and their correlation with MNV types, morphological and functional changes in exudative nAMD under long-term anti-VEGF therapy. We evaluated optical coherence tomography (OCT) volume scans in 143 eyes of 94 nAMD patients (start of anti-VEGF therapy 2009-2018, therapy until the last visit) and recorded the VA at all visits. HRM evolution patterns were differentiated: pattern 1 = no HRM, pattern 2 = subretinal HRM resolved during follow-up, pattern 3 = persistent subretinal HRM with new HRM-boundary remodeling [BR], pattern 4 = persistent subretinal HRM without HRM-BR. Pattern 1 was observed in 58 eyes (40.6%), 33 eyes (23.1%) showed pattern 2, 39 eyes (27.3%) pattern 3 and 13 eyes (9.1%) pattern 4. HRM pattern correlated with type 1-3 MNV (p = 0.02), especially pattern 1 with type 1 MNV and pattern 3 with type 2 MNV. Over time, a change of MNV types could be observed only from type 2 into type 1 MNV (p = 0.0001). Some eyes with HRM pattern 3 changed during follow-up into pattern 4, which was often associated with the presence of macular atrophy (p = 0.0001) and demonstrated a reduced mean VA compared to pattern 1-3 at baseline (p = 0.0001), year 1 (p = 0.0001) and final visit (p = 0.02).In this study, we characterized different HRM evolution patterns in a real-world dataset and demonstrated their associations with MNV transformation during long term anti-VEGF therapy. The HRM patterns may provide prognostic value with morphological and functional implications.