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Non-exudative OCT findings in neovascular AMD

Eye volume 39, pages 516–526 (2025)Cite this article

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Abstract

In this narrative review we describe the main optical coherence tomography biomarkers appearing in eyes with neovascular age-related macular degeneration (AMD) that do not directly correspond to exudation. We highlight those signs that may mimic exudation and therefore do not require active treatment, such as outer retinal tubulations, pseudocysts, lipid globules, or hyporeflective wedges. Other signs may indicate impending exudation such as hyperreflective foci or shallow irregular retinal pigment epithelium elevation, and therefore should be carefully monitored. We also review and summarize the different origins of subretinal hyperreflective material and describe the main signs of degeneration seen in eyes with AMD, such as outer retinal tubulation, thinning of the retinal layers, outer retinal atrophy, and choroidal changes.

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Fig. 1: Intraretinal pseudocysts vs outer retinal tubulation, and hyperreflective foci.
Fig. 2: Intraretinal pseudocysts vs outer retinal tubulation in association with multilayering pigment epithelium detachment with choroidal cleft.
Fig. 3: Subretinal hyperreflective material.
Fig. 4: Wedge-shaped subretinal hyporeflectivity.
Fig. 5: Shallow irregular retinal pigment epithelium (RPE) elevation, retinal thinning and RPE atrophy.

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Authors and Affiliations

  1. Unit of Macula, Oftalvist Clinic, Valencia, Spain

    Lourdes Vidal-Oliver & Rosa Dolz-Marco

  2. Ophthalmology Department, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany

    Lourdes Vidal-Oliver

  3. Ophthalmology Department, Basurto Hospital, Bilbao, Spain

    Pedro Fernández-Avellaneda

  4. Ophthalmology Unit, Department NESMOS, S. Andrea Hospital, University of Rome “La Sapienza”, Rome, Italy

    Serena Fragiotta

  5. Doheny Eye Institute, Pasadena, CA, USA

    Giulia Corradetti

  6. Department of Ophthalmology, University of California Los Angeles, Los Angeles, CA, USA

    Giulia Corradetti

  7. Department of Surgical Sciences, University of Turin, Turin, Italy

    Enrico Borrelli

  8. Department of Ophthalmology, “City of Health and Science” Hospital, Turin, Italy

    Enrico Borrelli

Authors
  1. Lourdes Vidal-Oliver
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  2. Pedro Fernández-Avellaneda
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  3. Serena Fragiotta
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  4. Giulia Corradetti
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  5. Enrico Borrelli
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  6. Rosa Dolz-Marco
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Contributions

LVO was responsible for conducting the literature search, extracting, and analysing data, updating reference lists. PFA, SF, GC, and EB provided feedback on the report, adding new references, and creating figures. RDM was responsible for designing the review content, organizing the manuscript and list of features, creating figures and captions, and reviewing the manuscript.

Corresponding author

Correspondence to Rosa Dolz-Marco.

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Competing interests

LVO reports travel expenses from Bayer; PFA is a consultant for Bayer and Roche; SF reports personal fees from Bayer (Advisor) outside the submitted work; GC none; EB is consultant to Abbvie, Bayer, Hofmann La Roche, Zeiss; RDM is consultant to Heidelberg Engineering and receives research funding from Roche, and Abbvie. The current manuscript received no funding.

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Vidal-Oliver, L., Fernández-Avellaneda, P., Fragiotta, S. et al. Non-exudative OCT findings in neovascular AMD. Eye 39, 516–526 (2025). https://doi.org/10.1038/s41433-024-03461-y

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