Hyperreflective foci on optical coherence tomography associate with treatment outcome for anti-VEGF in patients with diabetic macular edema

Abstract

PurposeTo investigate the relationship between baseline number of hyperreflective foci (HF) on spectral domain optical coherence tomography (SD-OCT) in patients with diabetic macular edema (DME), as well as the dynamics of HF during treatment with anti-vascular endothelial growth factor (VEGF), and treatment response.MethodsWe evaluated patients diagnosed with DME scheduled for treatment with intravitreal bevacizumab. Eyes were classified as adequate or insufficient treatment responders based on logMAR visual acuity improvement and central retinal thickness (CRT) decrease after three consecutive injections. Associations between number of HF at baseline and treatment response, the change in HF over the course of treatment, and the distribution of HF within the retinal layers were evaluated.ResultsIn 54 eyes of 41 patients, mean number of HF and CRT decreased after intravitreal treatment with bevacizumab (p = 0.002 and p<0.001 respectively). Decrease in CRT after 3 months was independently associated with a higher number of HF at baseline (estimated effect -2.61, 95% CI [-4.42–-0.31], p = 0.006). Eyes with adequate treatment response presented with more HF at baseline (OR 1.106, 95% CI [1.012–1.210], p = 0.030) than eyes with insufficient treatment response. Most HF were located within the inner retinal layers, and decrease of HF was mostly due to a decrease of inner retinal HF.ConclusionsIn patients with DME treated with anti-VEGF, higher baseline numbers of HF have predictive value for treatment response in terms of visual acuity improvement and CRT decrease after 3 months. In addition, HF were responsive to anti-VEGF therapy.

Retinal Hyperreflective Foci in Type 1 Diabetes Mellitus

“…The potential clinical relevance of HF was demonstrated in previous studies showing that HF may be a predictor of treatment response to intravitreal anti–vascular endothelial growth factor or corticosteroid therapy in DME. 20 , 22 In the current study, we observed significantly higher numbers of HF in all stages of DME versus patients without DME. The number of HF was especially high in severe DME, suggesting the presence of a strong link between HF and exudative retinal disease.…”

“…We further substantiated the relationship between HF and disease activity by the correlation we found between HF and visual acuity, in consistence with previous reports. 17 , 20 , 26 The occurrence of HF in diabetic patients may act as an early warning sign for oncoming vision loss. The exact nature of the relation of HF and visual acuity is yet unclear.…”

“…The retinal layers in the central 3 mm of the fovea-centered B-scan were assessed for the presence of HF. We defined HF as small, round or oval-shaped, well-circumscribed dense particles with higher reflectivity than the surrounding background, and a size of <100 µ m. 20 The infrared images were checked to exclude HF that corresponded to retinal vessels. The total number of HF between the inner nuclear layer and the external limiting membrane (ELM) was evaluated by means of manual annotations made by two trained graders (V.S.…”

Glucose-Regulated Protein 78 in the Aqueous Humor of Patients with Diabetic Macular Edema

“…We also assessed CST and macular morphology via OCT (Cirrus High-Definition OCT; Carl Zeiss Meditec, Dublin, CA, USA), and the axial length was measured using an IOL Master instrument (Carl Zeiss Meditec). We used a horizontal B-scan OCT image centered on the fovea for measuring hyperreflective foci (HF) and total length of ellipsoid zone (EZ) disruption within the central 3000 μm around the fovea [20,21]. We evaluated changes in CST at the 1-month visit after three consecutive monthly intravitreal bevacizumab (IVB) injections.…”

Verlaufskontrolle nach IVOM-Therapie bei diabetischem Makulaödem

“…Eine weitere Theorie beschreibt diese Foci als degenerierte Photorezeptorzellen [11]. In einer aktuellen multizentrischen Studie wurden diese HF untersucht und als möglicher Biomarker für den Erfolg der Anti-VEGF-Therapie und der Sehprognose eingestuft [12]. [14].…”