This 78YO female originally presented on 2/2/21 with decreased vision in her right eye from a treatment-naive macular neovascularization (MNV) with subretinal fluid on OCT.
The lesion became completely inactive after several monthly anti-VEGF injections (5/25/21).
She was then lost to follow-up due to other health issues and returned on 11/23/21 with an active lesion with overlying subretinal hyperreflective material (SHRM).
After several additional monthly injections, all exudation resolved with the disappearance of the SHRM (2/15/22).
Learning Points:
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 (see Willoughby et al., Ophthalmology 2015;122:1846-1853).
Persistent SHRM is associated with an increased incidence of scar formation and worse VA.
