Choroidal Hyperreflective Foci: A Novel Spectral Domain Optical Coherence Tomography Biomarker in Eyes With Diabetic Macular Edema

Abstract

Purpose: The aim of this study was to examine the hyperreflective dots seen in choroid on spectral domain optical coherence tomography (SDOCT) in eyes with diabetic macular edema (DME) and correlate it with visual acuity. Design: Consecutive, cross-sectional case series of patients with DME between January 2017 and December 2017. Methods: Eyes with DME having central foveal thickness ≥250 μm were included. SDOCT was performed using Spectralis system (Heidelberg Engineering, Germany). Hyperreflective choroidal foci (HCF) were defined as well-circumscribed dots within choroid having reflectivity equal to or higher than adjacent retinal pigment epithelium. HCF were counted manually within 1500 μm of fovea using a horizontal line scan by a blinded observer. Eyes were divided in 3 groups: group A (no HCF), group B (1–10 HCF), and group C (>10 HCF). Results: One hundred nineteen eyes of 60 DME patients were included. Sixty (50.4%) eyes were in group A, whereas 42 (33.6%) and 17 (14.2%) eyes belonged to group B and group C, respectively. The mean logMAR best corrected visual acuity was significantly lower in group B (0.76 ± 0.79) and C (1.2 ± 0.78) as compared with group A (0.22 ± 0.49) ( P = 0.001). Mean central foveal thickness in group A (300.4 ± 122.4 μm) was significantly lower than group B (455.52 ± 209.1 μm) and group C (529.4 ± 196.4 μm) with P value of 0.001. Conclusions: The present study describes HCF as novel prognostic SDOCT biomarker in DME whose presence denotes poor visual acuity. Further longitudinal studies are required to substantiate our findings.

Role of Epithelial-Mesenchymal Transition in Retinal Pigment Epithelium Dysfunction

“…Hyperreflective foci (HRF) are well-circumscribed lesions with equal or greater reflectivity than the RPE band that spread over various retinal and choroidal layers in spectral domain optical coherence tomography (SD-OCT) images (Liu S. et al, 2019;Roy et al, 2019). Numerous clinical studies have shown that retinal HRF appear in optical coherence tomography OCT images in retinal diseases, including age-related macular degeneration (AMD), inherited rod-cone degenerations, and inherited macular degenerations (Kuroda et al, 2014;Piri et al, 2015;Miura et al, 2017).…”

“…Numerous clinical studies have shown that retinal HRF appear in optical coherence tomography OCT images in retinal diseases, including age-related macular degeneration (AMD), inherited rod-cone degenerations, and inherited macular degenerations (Kuroda et al, 2014;Piri et al, 2015;Miura et al, 2017). HRF in choroid have been reported in Stargardts disease (Piri et al, 2015) and diabetic macular edema (DME) (Roy et al, 2019). The cellular origins of HRF were initially hypothesized to be migrated RPE cells, macrophages, or hard exudates.…”

Optical Coherence Tomography (Angiography) Biomarkers in the Assessment and Monitoring of Diabetic Macular Edema

“…Hyperreflective choroidal foci (HCF) were described recently, and they represent lipofuscin deposition in the choroidal layers [ 58 ]. HCF signal poor prognostic for visual acuity, their number being significantly higher in eyes with PDR versus NPDR [ 8 ].…”

Local Inflammatory Biomarkers and Potential Inflammation-Targeting Therapies in Diabetic Retinopathy

“…It is postulated that HCF represent HRF migrated from the retina, into the choroidal layers, which was permitted by ELM and EZ disruption (Figure 3). The hypothesis that HCF are actually migrated HRF, is supported by the study of Roy and al. where all 59 eyes with HCF had HRF as well and there was no eye which had HCF in the absence of HRF on SD-OCT [84]. Presence of HCF could be used as a biomarker of disease severity in eyes with DR [84].…”