Masking of macular neovascular membranes by subretinal hyperreflective material on optical coherence tomography angiography.

Purpose: The purpose of this study was to determine whether subretinal hyperreflective material (SHRM) may mask the detection of macular neovascular membranes (MNV) on optical coherence tomography angiography (OCTA).

Methods: In this observational study, eyes with active neovascular age-related macular degeneration (nAMD), co-existing SHRM & intraretinal or subretinal fluid or hemorrhage on structural OCT, underwent OCTA & fundus fluorescein angiography (FFA) imaging. 6 × 6 mm choriocapillaris and outer retinal slabs on OCTA were examined to determine the presence of MNV underneath the SHRM. The corresponding area on FFA was used as a reference arm to confirm activity.

Results: Thirty eyes of thirty patients with SHRM and active nAMD were recruited. All eyes failed to show a MNV in the choriocapillaris & avascular slabs of the OCTA underneath the SHRM, but showed active hyperfluorescent MNVs that increased in size and intensity in the late stages of FFA. In one eye, parts of a MNV under the SHRM were undetectable due to signal attenuation, while parts extending beyond the SHRM were detected on the choriocapillaris en face slab with flow on the B scan.

Conclusions: SHRM may act as a reflecting surface that limits the passage of light waves in OCTA, creating areas of signal attenuation and diminishing its ability to detect underlying MNVs.