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Etude de la corrélation entre les points hyperreflectifs intra-rétiniennes et l’activité des néovaisseaux choroïdiens dans les stries angioïdes

Angioid streaks (AS) are defined as irregular linear breaks in a degenerated Bruch's membrane, radiating from the peripapillary area, and involving the posterior pole. While AS are normally asymptomatic, their most important vision-threatening complication is represented by the development of choroidal neovascularization (CNV). Retinal hyperreflective foci (HF) is defined as small discrete, dot-shaped lesion, with greater reflectivity than the retinal pigment epithelium (RPE) band on spectral domain optical coherence tomography (SD-OCT). The aim of our study was to evaluate the changes in hyperreflective foci (HF) using SD-OCT in patients undergoing anti-VEGF treatment for choroidal neovascularization (CNV) secondary to angioid streaks (AS).

Nine eyes of 5 patients with diagnosis of AS-related CNV and 8 eyes of 4 patients with uncomplicated AS were included in the study. Patients and controls underwent complete ophthalmologic examination and SD-OCT. HF were assessed on the horizontal scan of a six-line radial SD-OCT in the fovea and parafovea. Patients were subjected to a pro re nata treatment regimen (PRN); including monthly examinations and intravitreal aflibercept injection in case of fluid detection on SD-OCT. HF were analyzed at the following time points: baseline, dry on SD-OCT and the time of CNV reactivation.

Nine treatment-naïve eyes of 5 patients with clinical diagnosis of CNV secondary to AS, eight being males (53.3%), were consecutively recruited for the study. Four patients with uncomplicated AS served as age- and sex-matched controls. The mean age of patients and controls was 55.5 ± 13.5 (range, 29–79), and 54.6 ± 14.6 years. Mean BCVA in the treated eyes improved from 20/100 at the moment of CNV activity detection to 20/63 at the end of the follow-up. All the patients underwent Aflibercept injections required by the PRN regimen over a mean follow-up of 6.2 ± 1.8 months, requiring a mean of 2.9 ± 1.1 injections. HF numbers resulted higher in all CNV phases with respect to controls. We observed that patients with active CNV had a larger number of retinal and choroidal HF when compared with others phases. HF numbers were found to differ significantly between the various phases (P < 0.005), being considerably higher in eyes affected by CNV compared with the controls at any time point, except during the inactive CNV phase. Foveal HF turned out to be significantly elevated when the CNV was active, whether at baseline (12.7 ± 5.4 and 11.7 ± 3.7) respectively or at reactivation (11.4 ± 4.9 and 13.1 ± 3.8) respectively, when compared with the inactive CNV phase (5.6 ± 2.6 and 5.5± 2.4). Our correlational analysis revealed a negative association between intraretinal HF numbers and BCVA.

Recent studies suggested that HFs may predict the final visual outcome in many retinal disorders including diabetic macular edema and age-related macular degeneration. HF monitoring by means of SD-OCT can predict fluid formation consistent with the activation of the CNV, potentially enabling prompt retreatment to be performed before visual acuity deteriorates.

Our findings suggest that HF represent useful markers to monitor CNV activity. Further research is needed to validate our results.