Hyperreflective Retinal Spots in Normal and Diabetic Eyes

Vujosevic, Stela; Bini, Silvia; Torresin, Tommaso; Berton, Marianna; Midena, Giulia; Parrozzani, Raffaele; Martini, Ferdinando; Pucci, Porzia; Daniele, Anna Rita; Cavarzeran, Fabiano; Midena, Edoardo

doi:10.1097/iae.0000000000001304

Cited by 108 publications

(67 citation statements)

References 23 publications

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“… 28 These include HRS, visible on OCT, and considered the signs of activated microglial cells in the retina. 29 These HRS have peculiar features, such as dimension <3 0 μm, reflectivity similar to that of the nerve fiber layer, absence of back-shadowing, and location in both the inner and outer retina. 29 Previous studies have demonstrated a decrease in the number of HRS after treatment with both intravitreal dexamethasone and anti-VEGF drugs 23 , 30 , 31 ; however, no evidence has been reported so far regarding the effect of SMPL on HRS during long-term follow-up.…”

Section: Discussionmentioning

confidence: 98%

Subthreshold Micropulse Laser in Diabetic Macular Edema: 1-Year Improvement in OCT/OCT-Angiography Biomarkers

Vujosevic

Toma

Villani

et al. 2020

Trans. Vis. Sci. Tech.

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The aim of this study was to evaluate 1-year quantitative changes in specific inflammatory parameters on optical coherence tomography (OCT) / optical coherence tomography angiography (OCTA) in diabetic macular edema (DME) treated with subthreshold micropulse laser (SMPL). Methods: Thirty-seven patients / eyes with previously treatment-naïve DME treated with SMPL were prospectively evaluated at 3, 6, and 12 months. Fifteen fellow eyes with only microaneurysms (MAS) not eligible for treatment were controls. Evaluated OCT / OCTA parameters included: central macular thickness (CMT); hyper-reflective retinal spots (HRS); disorganization of inner retinal layers (DRILs); MA in the superficial / deep capillary plexuses (SCP/DCP); cysts in the area at the SCP / DCP; and macular perfusion parameters (MATLAB, version 2017b). Results: In the treated group, mean best corrected visual acuity (BCVA) progressively increased from 69.4 ± 12.0 to 76.0 ± 9.1 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (P < 0.001) at 12 months; HRS decreased from baseline (80.75 ± 20.41) at 3 (73.81 ± 17.1, P = 0.002), 6 (69.16 ± 16.48, P < 0.0001), and 12 months (66.29 ± 18.53, P < 0.0001). MA decreased at 3 months in the DCP (P = 0.015), at 6 and 12 months in both plexuses (P ≤ 0.0007). BCVA, HRS, and MA remained stable in the controls during all follow-ups. DRIL was present in 18 of 37 patients at baseline and progressively decreased from 557.0 ± 238.7 to 387.1 ± 282.1 μm (P = 0.01). The area of cyst decreased both in the SCP (P = 0.03) and the DCP (P = 0.02). CMT and perfusion parameters did not change. Conclusions: SMPL reduced the number of HRS (sign of activated microglia cells in the retina), MA, DRIL extension, and the area of cysts. Further studies are needed to confirm these preliminary data on the anti-inflammatory effect of SMPL, and to explore the mechanism of action. Translational Relevance: The follow-up of OCT/OCTA noninvasive biomarkers offers a unique insight in the mechanism of laser action, suggesting an anti-inflammatory effect of SMPL.

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Section: Discussionmentioning

confidence: 98%

Subthreshold Micropulse Laser in Diabetic Macular Edema: 1-Year Improvement in OCT/OCT-Angiography Biomarkers

Vujosevic

Toma

Villani

et al. 2020

Trans. Vis. Sci. Tech.

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“…One study recently evaluated characteristics of these hyperreflective “spots” and compared them with features on en face images. 7 They suggested that when larger than 30μm, these spots may represent hard exudate in the outer retina. For DME patients, Bolz et al suggests that HRM may represent subclinical extravasation of lipoproteins and/or proteins, secondary to breakdown of the blood retinal barrier.…”

Section: Discussionmentioning

confidence: 99%

Suspended Scattering Particles in Motion: A Novel Feature of OCT Angiography in Exudative Maculopathies

Kashani

Green

Kwon

et al. 2018

Ophthalmology Retina

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“…The study presented here further showed that morphological features like center-involving intraretinal hyperreflective material detected by SD-OCT may represent a negative predictive factor in the eyes with DME because the initially observed inferior VA of the eyes revealing intraretinal hyperreflective foci at baseline remained until the end of the follow-up period (0.39; 20/50 Snellen (SD = 0.25) versus 0.68; 20/63 Snellen (SD = 0.22), p =25, Table 3 ). Hyperreflective intraretinal spots define exudates as visible clinically and were described previously by Vujosevic et al [ 17 ]. Hyperreflective structures seen in SD-OCT correlated to hard exudates observed in biomicroscopy in our study.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Diabetic Macular Edema with Intravitreal Antivascular Endothelial Growth Factor and Prompt versus Deferred Focal Laser during Long-Term Follow-Up and Identification of Prognostic Retinal Markers

Weingessel

Miháltz

Gleiß

et al. 2018

Journal of Ophthalmology

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Purpose Long-term follow-up of patients with diabetic macular edema (DME) treated with intravitreal antivascular endothelial growth factor (anti-VEGF) combined focal laser and identification of prognostic morphological characteristics. Methods Prospective clinical trial (50 treatment-naive eyes) with DME randomized 1 : 1 receiving intravitreal ranibizumab (0.5 mg/0.05 ml) and prompt grid laser compared with ranibizumab and deferred laser. Morphological characteristics potentially relevant for prognosis were assessed at baseline, month 6, month 9, and years 1, 2, 3, 4, and 5 of follow-up. Results Although functional results were slightly higher in the prompt group at week 12 (0.5; 20/40 Snellen (SD = 0.04, 0.3 logMAR) versus 0.4; 20/50 Snellen (SD = 0.04, logMAR: 0.4), p=0.4) and month 9 (prompt group: 0.5; 20/40 Snellen (SD = 0.03, 0.3 logMAR) versus deferred group: 0.4; 20/50 Snellen (SD = 0.04, 0.4 logMAR), p=0.4), these were statistically insignificant. There was no significant benefit regarding functionality during long-term follow-up in the prompt group compared to the deferred group. BCVA in the eyes with clusters of hyperreflective foci in the central macular region was inferior compared with the eyes without these alterations at year 5 (0.39; 20/50 Snellen, (SD = 0.25, 0.4 logMAR) versus 0.63; 20/80 Snellen (SD = 0.22, 0.2 logMAR), p < 0.01). Conclusion Grid laser and ranibizumab therapy are effective in DME management during the long-term follow-up. Intraretinal hyperreflective material in SD-OCT is negatively related to BCVA.

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Hyperreflective Retinal Spots in Normal and Diabetic Eyes

Cited by 108 publications

References 23 publications

Subthreshold Micropulse Laser in Diabetic Macular Edema: 1-Year Improvement in OCT/OCT-Angiography Biomarkers

Subthreshold Micropulse Laser in Diabetic Macular Edema: 1-Year Improvement in OCT/OCT-Angiography Biomarkers

Suspended Scattering Particles in Motion: A Novel Feature of OCT Angiography in Exudative Maculopathies

Treatment of Diabetic Macular Edema with Intravitreal Antivascular Endothelial Growth Factor and Prompt versus Deferred Focal Laser during Long-Term Follow-Up and Identification of Prognostic Retinal Markers

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