In Vivo Characterization of Bruch's Membrane Breaks in Neovascular Age-Related Macular Degeneration Using High-Resolution Optical Coherence Tomography.

Purpose: The purpose of this study was to investigate the frequency and characteristics of Bruch's membrane (BM) breaks, and their relationship with clinically relevant outcomes in neovascular age-related macular degeneration (nAMD). Methods: Forty-seven eyes (39 patients) with nAMD and type 1 macular neovascularization (MNV) were imaged using high-resolution optical coherence tomography (High-Res OCT; Heidelberg). Foveal-centered 20 degrees × 20 degrees volume scans (1024 × 97, automated real time [ART] = 5-25) were obtained. BM breaks, defined as definite interruptions in the hyper-reflective BM band, were identified within the MNV region. The maximum break extent was measured. Break density, distribution, and eccentricity were also evaluated. BM break parameters were correlated with visual acuity and number of intravitreal injections. Results: Thirty eyes were included for quantitative analysis. Multiple breaks were observed in 76.7% of eyes, with a mean of 4.30 ± 4.15 breaks/eye. Notably, breaks showed a preferential eccentric distribution, tending to be closer to the lesion border (mean eccentricity ratio = 4.33 ± 3.61). Our model suggested that a higher break count was significantly associated with higher injection number (P = 0.042), whereas a greater break length was associated with fewer injections (P = 0.001). There was a trend for a higher break count to be associated with better BCVA, but this was not statistically significant (P = 0.099). Conclusions: Most MNV lesions demonstrated multiple breaks with a tendency for breaks to be in the lesion periphery. The identification of BM breaks appeared to be of clinical relevance as the number and length of the breaks were associated with the number of intravitreal injections. Larger prospective studies are warranted to confirm these findings.