This 80YO female presented with counting-fingers vision in her left eye from treatment-naive neovascular AMD (nAMD).
Triton color photography shows a few retinal hemorrhages and more peripheral large drusen. Swept-source OCT shows a shallow irregular RPE detachment with underlying type 1 macular neovascularization (MNV). A hyporeflective prechoroidal cleft is noted below the MNV and subretinal hyperreflective material (SRHM) above. There is shallow outer retinal fluid above the SRHM. Subretinal fluid is seen on either side of the MNV. Intravitreal Avastin therapy was begun.
Learning Points:
Our patient’s OCT includes numerous findings of active MNV, including SRHM, prechoroidal cleft, and subretinal and intraretinal fluid.
SHRM is an OCT finding that is invisible clinically. This material, located between the neurosensory retina and retinal pigment epithelium (RPE), is thought to consist of fluid, fibrin, blood, and other fibrovascular tissues. SHRM is a biomarker of active disease that decreases with successful anti-VEGF therapy (Willoughby et al, Ophthalmology 2015;122:1846-1853). Persistent SHRM is associated with an increased incidence of scar formation and worse vision.
A prechoroidal cleft is a hyporeflective space between the RPE and Bruch’s membrane. It is seen in up to 20% of treated eyes with nAMD, particularly with type 3 neovascularization (intraretinal MNV) and polypoidal choroidal vasculopathy. They are usually associated with worse visual acuity due to potential complications, including RPE tears and subretinal hemorrhages (Kim et al, Retina 2017;37:2047-2055).
