Filik Armagan, Gungel Hulya
Department of Ophthalmology, Agri Patnos State Hospital, Agri, Turkey.
Department of Ophthalmology, Saglık Bilimleri University, Istanbul Training and Research Hospital, Istanbul, Turkey.
Oman J Ophthalmol. 2022 Jun 29;15(2):182-187. doi: 10.4103/ojo.ojo_139_21. eCollection 2022 May-Aug.
Subretinal hyperreflective material (SHRM) is a hyperrefiective material seen on optical coherence tomography (OCT) and located under the retina and above the retinal pigment epithelium. This study aims to examine the effect of SHRM on the functional prognosis of age-related macular degeneration (AMD) patients who switched from intravitreal ranibizumab to intravitreal aflibercept treatment.
This is a retrospective, nonrandomized clinical study. AMD patients meeting the switching criteria underwent a complete ophthalmic examination, including spectral-domain OCT and fundus fluorescein angiography. The best-corrected visual acuity and OCT parameters were measured at the switch and 3, 6, 12, and 24 months after. SHRM(+/-), maximum SHRM thickness, and subjective and objective reflectivity stages of SHRM (grades 1-3) were evaluated.
SHRM was observed in 24/48 (50.0%) of eyes at the time of the switch. The differences in maximum SHRM thicknesses were not statistically significant. SHRM's mean subjective reflectivity stages at the switch and subsequent examinations were 2.37, 2.75, 2.75, 2.74, and 2.81; SHRM's objective reflectivity staging also confirmed them. Functional changes after the switch showed a significant VA loss in the SHRM(+) group and significant gain in the SHRM(-) group.
This study showed that the presence of SHRM and higher optical reflectivity at the switch from ranibizumab to aflibercept caused a poor prognosis after the switch. On the other hand, SHRM(-) patients achieved good functional results after the switch.
视网膜下高反射物质（SHRM）是在光学相干断层扫描（OCT）上看到的位于视网膜下方和视网膜色素上皮上方的高反射物质。本研究旨在探讨SHRM对从玻璃体内注射雷珠单抗转换为玻璃体内注射阿柏西普治疗的年龄相关性黄斑变性（AMD）患者功能预后的影响。
这是一项回顾性、非随机临床研究。符合转换标准的AMD患者接受了全面的眼科检查，包括光谱域OCT和眼底荧光血管造影。在转换时以及转换后3、6、12和24个月测量最佳矫正视力和OCT参数。评估SHRM（±）、最大SHRM厚度以及SHRM的主观和客观反射率阶段（1-3级）。
转换时在24/48（50.0%）的眼中观察到SHRM。最大SHRM厚度的差异无统计学意义。转换时及后续检查中SHRM的平均主观反射率阶段分别为2.37、2.75、2.75、2.74和2.81；SHRM的客观反射率分期也证实了这些结果。转换后的功能变化显示，SHRM（+）组视力显著下降，SHRM（-）组视力显著提高。
本研究表明，从雷珠单抗转换为阿柏西普时SHRM的存在和较高的光学反射率导致转换后预后不良。另一方面，SHRM（-）患者在转换后取得了良好的功能结果。
