Morphologic and Microvascular Differences Between Macular Neovascularization With and Without Subretinal Fibrosis

Area of Science:

• Ophthalmology
• Retinal Diseases
• Medical Imaging

Background:

• Neovascular age-related macular degeneration (nAMD) is a leading cause of vision loss.
• Subretinal fibrosis (SF) is a common complication of nAMD, impacting visual outcomes.
• Understanding the morphological and microvascular characteristics of SF is crucial for patient management.

Purpose of the Study:

• To compare morphologic and microvascular features between eyes with and without subretinal fibrosis (SF) in nAMD.
• To identify potential imaging biomarkers associated with SF in nAMD.

Main Methods:

• Prospective cross-sectional study of patients with nAMD and at least 12 months of anti-VEGF treatment.
• Utilized swept-source optical coherence tomography angiography for quantitative microvascular analysis.
• Employed polarization-sensitive OCT for automated SF segmentation and evaluated for reticular pseudodrusen, hyperreflective foci (HRF), and outer retinal tubulation (ORT).

Main Results:

• Eyes with SF showed a higher prevalence of ORT (P < 0.001) and lower prevalence of HRF (P = 0.004).
• SF eyes exhibited significantly larger greatest vascular caliber, greatest linear diameter, and microvascular neovascularization (MNV) area.
• Quantitative microvascular analysis revealed increased vessel area, junctions, total length, and endpoints in eyes with SF.

Conclusions:

• Multimodal imaging reveals in vivo microvascular and morphological differences in eyes with and without SF.
• Eyes with SF are characterized by larger MNV lesions, thicker vessels, and are often associated with ORT.
• Identified imaging biomarkers may aid in identifying nAMD patients at higher risk for SF.