Prognostic value of subretinal hyperreflective material as an imaging biomarker in the treatment of neovascular age-related macular degeneration: A systematic review.

内容摘要

Subretinal hyperreflective material (SHRM) is now recognized as a biomarker in neovascular age-related macular degeneration (nAMD), with potential prognostic value for visual and structural outcomes. We synthesize and critically evaluate the evidence on the prognostic role of SHRM characteristics in patients with nAMD. We conducted a systematic search of PubMed, Scopus and Web of Science for studies published between March, 2015, and March, 2025. Eligible studies included human participants with nAMD, under anti-vascular endothelial growth factor (anti-VEGF) treatment, in which SHRM was assessed using optical coherence tomography and outcomes included best-corrected visual acuity (BCVA), fibrosis and macular atrophy. Thirty-three studies met the inclusion criteria. Most of the studies demonstrated a significant association between the presence of SHRM and worse BCVA over time, particularly correlated to SHRM thickness, width or persistence after anti-VEGF therapy. Well-defined and hyperreflective SHRM was repeatedly linked to poorer functional outcomes. Twelve studies reported SHRM as a strong predictor of subretinal fibrosis, with larger size, defined borders and persistence conferring the greatest risk. The relationship with macular atrophy was less clear; while some studies suggested that thicker or persistent SHRM increased the likelihood of atrophy, others found no association. Overall, the evidence suggests that SHRM is a strong imaging biomarker of poor prognosis in nAMD. While this review highlights consistent patterns, differences in how SHRM is measured remain a limitation. It will be important for future research to standardize SHRM assessment and establish its use in personalized treatment decisions.