title: Subretinal Hyperreflective Material Imaged With Optical Coherence Tomography Angiography.
abstract: OBJECTIVE
  The range of subretinal hyperreflective material (SHRM) seen in macular disease includes type 2 macular neovascularization, fibrosis, exudation, vitelliform material, and hemorrhage. The prognostic significance of SHRM has been evaluated retrospectively in clinical trials, but discriminating SHRM subtypes traditionally requires multiple imaging modalities. The purpose of this study is to describe optical coherence tomography angiography (OCTA) flow characteristics and artifacts that might help to distinguish SHRM subtypes.
  
  
  METHODS
  Validity analysis.
  
  
  METHODS
  Patients with age-related macular degeneration (AMD), myopia, pachychoroid disease, and macular dystrophy, manifesting SHRM on optical coherence tomography (OCT), were recruited. Clinical chart review and multimodal imaging established the SHRM subtype. All patients underwent OCTA. OCT and OCTA images were examined together for (1) intrinsic flow, (2) retinal projection onto the anterior SHRM surface (strong, weak, absent), (3) retinal projection through SHRM onto retinal pigment epithelium (RPE), and (4) masking of choriocapillaris flow.
  
  
  RESULTS
  Thirty-three eyes of 25 patients were included (type 2 neovascularization ×3; fibrosis ×4; exudation ×10; hemorrhage ×5; vitelliform ×17). Mean age per eye was 76 years (standard deviation: 12). Intrinsic flow was strongest in type 2 neovascularization. Subretinal fibrosis showed limited flow in residual large-caliber vessels and branches. Flow was not detected within foci of exudation, hemorrhage, or vitelliform lesions. Retina-SHRM surface projection was strongest onto smooth-surfaced SHRM and weaker onto exudation. Retinal projection was weakest on the surface of vitelliform lesions. Retina-RPE projection was masked by dense hemorrhage and vitelliform material. In compound SHRM, OCTA distinguished between vascular and avascular components.
  
  
  CONCLUSIONS
  Optical coherence tomography angiography can distinguish vascular from avascular SHRM components. OCTA artifacts may distinguish certain avascular SHRM components.
authors.affiliation: Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska; Moorfields Eye Hospital, London, United Kingdom.
authors.forename: Kunal K
authors.initials: KK
authors.lastname: Dansingani
authors.affiliation: Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; Singapore National Eye Center, Singapore Eye Research Institute, Singapore.
authors.forename: Anna C S
authors.initials: ACS
authors.lastname: Tan
authors.affiliation: Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York.
authors.forename: Fatimah
authors.initials: F
authors.lastname: Gilani
authors.affiliation: Stein Eye Institute, University of California, Los Angeles, Los Angeles, California; Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Nopasak
authors.initials: N
authors.lastname: Phasukkijwatana
authors.affiliation: New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts; Federal University of São Paulo, School of Medicine, São Paulo, Brazil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Novais
authors.affiliation: University Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Lea
authors.initials: L
authors.lastname: Querques
authors.affiliation: New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Nadia K
authors.initials: NK
authors.lastname: Waheed
authors.affiliation: New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Jay S
authors.initials: JS
authors.lastname: Duker
authors.affiliation: University Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Querques
authors.affiliation: Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Yannuzzi
authors.affiliation: Stein Eye Institute, University of California, Los Angeles, Los Angeles, California; Greater Los Angeles VA Healthcare Center, Los Angeles, California.
authors.forename: David
authors.initials: D
authors.lastname: Sarraf
authors.affiliation: Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York. Electronic address: kbfnyf@aol.com.
authors.forename: K Bailey
authors.initials: KB
authors.lastname: Freund
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015862:Choroid Diseases / Q000175:diagnosis; D005122:Exudates and Transudates; D005260:Female; D005355:Fibrosis / Q000175:diagnosis; D005451:Fluorescein Angiography; D006801:Humans; D008062:Lipofuscin / Q000378:metabolism; D008268:Macular Degeneration / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009216:Myopia / Q000175:diagnosis; D015593:Retinal Drusen / Q000175:diagnosis*; D012166:Retinal Hemorrhage / Q000175:diagnosis*; D041623:Tomography, Optical Coherence; D057826:Vitelliform Macular Dystrophy / Q000175:diagnosis* / Q000378:metabolism; D057135:Wet Macular Degeneration / Q000175:diagnosis*
chemical_list: D008062:Lipofuscin