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. 2021 Jan 1;41(1):135-143.
doi: 10.1097/IAE.0000000000002815.

SUB-RETINAL PIGMENT EPITHELIUM MULTILAMINAR HYPERREFLECTIVITY AT THE ONSET OF TYPE 3 MACULAR NEOVASCULARIZATION

Alexandra Miere  1 , Riccardo Sacconi  2 , Francesca Amoroso  1 , Vittorio Capuano  1   2 , Camille Jung  1 , Francesco Bandello  2 , Eric H Souied  1 , Giuseppe Querques  1   2
Affiliations

SUB-RETINAL PIGMENT EPITHELIUM MULTILAMINAR HYPERREFLECTIVITY AT THE ONSET OF TYPE 3 MACULAR NEOVASCULARIZATION

Alexandra Miere et al. Retina. .

Abstract

Purpose: To report the prevalence and treatment outcomes of eyes with sub-retinal pigment epithelium (sub-RPE) multilaminar hyperreflectivity at the onset/clinical detection of Type 3 macular neovascularization (MNV) secondary to exudative age-related macular degeneration.

Methods: Retrospective analysis of consecutive patients diagnosed with Type 3 MNV secondary to age-related macular degeneration was performed. Eyes presenting with sub-RPE multilaminar hyperreflectivity on structural optical coherence tomography at the onset of Type 3 MNV were included in this study. An age-, sex-, and stage-matched control group was composed of eyes affected by Type 3 MNV without sub-RPE multilaminar hyperreflectivity. Prevalence and treatment outcomes after anti-vascular endothelial growth factor injections at 1-year follow-up were analyzed in both groups.

Results: Nineteen treatment-naïve eyes of 19 patients (8 men/11 women, mean age 83 ± 8 years old) presenting with sub-RPE multilaminar hyperreflectivity before or at the onset/clinical detection of Type 3 MNV were included from a cohort of 162 eyes with treatment-naïve Type 3 MNV. This accounts for an estimated prevalence of 11.7% (5.8-15.2, 95% confidence intervals). No significant differences were disclosed between cases studied and the control group (143 eyes of 143 patients) in age, sex, best-corrected visual acuity at baseline, and number of injections. Best-corrected visual acuity did not improve during the 1-year follow-up in patients showing sub-RPE multilaminar hyperreflectivity (P = 0.45), whereas best-corrected visual acuity significantly increased in the control group (P < 0.001). The presence of sub-RPE multilaminar hyperreflectivity in the context of Type 3 MNV was significantly associated with regressive calcific drusen (P < 0.001) and multiple Type 3 lesions/eye (P < 0.001).

Conclusion: The detection of multilaminar hyperreflectivity at the onset/clinical detection of Type 3 MNV suggests that chronic exudation (i.e., the "onion-sign") in the sub-RPE space (i.e., focal sub-RPE neovascularization) may precede the onset/clinical detection of Type 3 MNV. Sub-retinal pigment epithelium multilaminar hyperreflectivity at the onset of Type 3 MNV may be an important predictor of poor visual outcome in these eyes.

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Comment in

  • Correspondence.
    Haj Najeeb B, Deak GG, Gerendas BS, Schmidt-Erfurth U. Haj Najeeb B, et al. Retina. 2022 Jan 1;42(1):e10-e11. doi: 10.1097/IAE.0000000000003355. Retina. 2022. PMID: 34861661 No abstract available.
  • Reply.
    Miere A, Sacconi R, Amoroso F, Capuano V, Jung C, Bandello F, Souied EH, Querques G. Miere A, et al. Retina. 2022 Jan 1;42(1):e11-e12. doi: 10.1097/IAE.0000000000003356. Retina. 2022. PMID: 34907130 No abstract available.

References

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    1. Sacconi R, Sarraf D, Garrity S, et al. Nascent type 3 neovascularization in age-related macular degeneration. Ophthalmol Retina 2018;2:1097–1106.

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