Hyperreflective Vasculature: A Negative Prognostic Sign for Retinal Vein Occlusion on Near-Infrared Reflectance Imaging

To investigate the clinical significance of hyperreflective vasculature visualized on near-infrared reflectance (NIR) in patients with retinal vein occlusion (RVO).In this retrospective study, RVO patients with NIR imaging and at least 1-year follow-up, and without confounding disease, were included. Two blinded independent graders identified vascular hyperreflectivity (HR) by detection of whiter signals in vessels. Visual acuity (VA), macular thickness (MT), and number of administered anti-vascular endothelial growth factor (anti-VEGF) injections were assessed.RVO patients with HR (n = 20) and without HR (n = 31) demonstrated similarity in age, sex, and class of RVO. At presentation, the HR group had higher MT (P = 0.002) but no difference in VA (P = 0.1018). At 1 year, patients with HR had worse VA (P = 0.001), decreased MT (P = 0.011), and received more anti-VEGF injections (P < 0.001).RVO patients with HR on NIR had significantly worse visual outcomes. Vascular HR on NIR imaging may be a biomarker, portending worse visual prognoses in RVO. [Ophthalmic Surg Lasers Imaging Retina 2023;54:266-270.].