SHRM in Pachychoroid Neovasculopathy – A Biomarker for Atrophy and IRF

Topic: Subretinal Hyperreflective Material, Atrophy, and Intraretinal Fluid in Pachychoroid Neovasculopathy (PNV)
Reference: Baek J, Ra H, Lee SH, Cheung CMG, Lee WK. Am J Ophthalmol. 2025;280:472–480.

Key Findings at a Glance

A recent retrospective study of 120 PNV eyes treated with anti-VEGF for over 1 year reveals critical insights into the role of subretinal hyperreflective material (SHRM) as a significant imaging biomarker linked to structural complications and visual outcomes.

1. SHRM Prevalence and Regression

• 47.5% of eyes had SHRM at baseline.

• 85% of SHRM regressed after 1 year of anti-VEGF therapy.

• However, SHRM persistence was associated with worse BCVA and thinner CMT.

2. SHRM and Atrophy: A Strong Link

• 40% of eyes developed atrophy within 1 year.

• 83.3% of atrophy cases occurred in eyes with baseline SHRM.

• SHRM (+) eyes had 8.45x higher odds of developing atrophy (OR 8.45, 95% CI 3.04–23.51).

3. SHRM, Fibrosis, and IRF

• Fibrosis developed in 21.7% of eyes, with 92.3% in SHRM (+) eyes.

• IRF was significantly more prevalent in SHRM (+) eyes and showed limited resolution compared to SRF.

• Unlike SRF, IRF persisted despite treatment, indicating a chronic, anti-VEGF-resistant process.

4. Visual and Structural Outcomes

• SHRM (+) eyes had:

  • Worse BCVA at all timepoints.

  • Thinner CMT at 3 months and 1 year.

  • More injections (5.12 vs. 3.75 in SHRM (-) group).

5. Clinical Implications

• SHRM is not just a biomarker of activity—it’s a predictor of structural damage.

• Atrophy in PNV is often focal and small, distinct from GA in AMD.

• IRF in PNV may be driven by choroidal vascular hyperpermeability (CVH) and atrophy, suggesting a need for adjuvant therapies targeting the choroid and inflammation.

This weblog post is based on the article “Subretinal Hyperreflective Material, Atrophy, and Intraretinal Fluid in Pachychoroid Neovasculopathy” published in the American Journal of Ophthalmology (2025). For detailed methodology and statistical analysis, please refer to the original publication.

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