Hyperreflective Foci Precede Macular Neovascularization Formation in Angioid Streaks.

Abstract

To describe the steps leading to the development and progression of macular neovascularization (MNV) in angioid streaks (AS). The study was designed as retrospective, longitudinal case-series. AS patients were investigated by means of multimodal imaging, including fundus autofluorescence and structural optical coherence tomography (OCT). Main outcome measures were hyperreflective foci (HF) and MNV progression steps. Overall, 40 eyes (20 patients) affected by AS were evaluated. Over the follow-up, 5 eyes of 5 patients developed MNV. The mean follow-up was of 1.6 years. The mean number of anti-VEGF injections was 4.35±1.4. Mean BCVA was 0.53±0.38 LogMAR at the MNV onset, improving to 0.42±0.40 LogMAR at the end of the follow-up (p>0.05). Intraretinal HF onset and coalescence represented the first alterations occurring before the onset of the MNV. Anti-VEGF treatment was associated with exudation relapsing and remitting, with still present intraretinal hyperreflective foci and pigment accumulation. The longitudinal analysis of our cohort of eyes outlined the event timeline: 1.2 months to find concentrated HF, 4.5 months to observe pigment organization through the outer nuclear layer, and 1.5 years to detect MNV. HF formation, concentration and migration represent early alterations occurring before the onset of the MNV in AS.