Topographical Quantification of Hyper-Reflective Foci May Predict the Development of Macular Atrophy in Patients With Neovascular Age-Related Macular Degeneration

PURPOSE. The purpose of this study was o examine the optical coherence tomographic (OCT) characteristics of hyper-reflective foci (HRF) in patients with neovascular age-related macular degeneration (nAMD) and to assess the potential of HRF as a predictive factor for the development of macular atrophy following anti-vascular endothelial growth factor (anti-VEGF) therapy. METHODS. This was a retrospective analysis of 61 treatment-naïve eyes diagnosed with exudative AMD and type 1 macular neovascularization (MNV). The HRF was identified in the inner retina and outer retina layers, and the treatment response of HRF was documented. An analysis was conducted to explore the association between HRF and the development of macular atrophy. RESULTS. The number of HRF in the inner retina and outer retina layers showed significant reduction after 12 months of anti-VEGF treatment (P = 0.002 and P < 0.0001, respectively). Similarly, compared with baseline, the number of HRFs in the inner retina and outer retina layers was significantly reduced after 24 months of anti-VEGF treatment (P = 0.002 and P < 0.0001, respectively). Moreover, the multivariate linear regression analysis revealed that the most substantial associations observed with the development of macular atrophy after 12 months were specifically tied to the number of HRFs in the outer retina (P = 0.039) at the baseline visit. This finding was confirmed after 24 months of anti-VEGF treatment (P = 0.007). CONCLUSIONS. After only 1 year of antiangiogenic therapy, there was a significant decrease in HRFs observed across all retinal layers. This reduction persisted even after 2 years of anti-VEGF treatment. Notably, the quantity of HRFs in the outer retina at baseline exhibited a correlation with the development of macular atrophy that endured at both the 1-year and 2-year follow-ups after anti-VEGF treatment.