Multimodality analysis of Hyper-reflective Foci and Hard Exudates in Patients with Diabetic Retinopathy

Niu, Sijie; Yu, Chenchen; Chen, Qiang; Yuan, Songtao; Lin, Jing; Fan, Wen; Liu, Qinghuai

doi:10.1038/s41598-017-01733-0

Cited by 32 publications

(28 citation statements)

References 32 publications

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“…As BCVA generally improved as treatment with ranibizumab progressed, it may be suggested that a reduction of intraretinal hyperreflective foci followed by anti-VEGF therapy may at least partly represent a positive predictive morphological feature in the eyes with DME. This assumption has also been suggested previously [ 18 ], it and is supported by our findings during an observation period of 5 years.…”

Section: Discussionsupporting

confidence: 93%

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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Section: Discussionsupporting

confidence: 93%

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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“…Hyper-reflective foci When monitoring the retina of wet AMD patients using spectral domain optical coherence tomography (SD-OCT), small, dense particles-thereby referred to as hyper-reflective foci (HF)-were identified (Framme et al, 2010;Altay et al, 2016). Similarly, HF were found in eyes of patients with different stages of diabetic retinopathy (De Benedetto et al, 2015;Korot et al, 2016), and a positive correlation between HF number, hard exudate size, disease severity, and inflammation has been recognized (Bolz et al, 2009;Lammer et al, 2014;Niu et al, 2017). Interestingly, the appearance and resolution of HF can be used to complement current diagnostic tools and predict disease progression and therapeutic success (Gallagher et al, 2007;Coscas et al, 2013;Abri Aghdam et al, 2015).…”

Section: Mononuclear Phagocyte-targeted Therapy In Patients With Retimentioning

confidence: 89%

“…Recent studies demonstrated that ROS-TXNIP pathway mediates NLRP3 inflammasome activation in DR conditions in vitro and in vivo in rats. High glucose induces sustained upregulation of TXNIP, ROS generation, and inflammation in a Müller cell line of rats, and antioxidants or TXNIP silencing blocked IL-1b and IL-18 secretion in high-glucose-exposed human retinal microvascular endothelial cells (Devi et al, 2012;Chen et al, 2017). These results provide a potential therapeutic target for the treatment of DR.…”

Section: Triggers Of Inflammasome Activation In the Retinamentioning

confidence: 96%

Modulation of three key innate immune pathways for the most common retinal degenerative diseases

et al. 2018

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This review highlights the role of three key immune pathways in the pathophysiology of major retinal degenerative diseases including diabetic retinopathy, age‐related macular degeneration, and rare retinal dystrophies. We first discuss the mechanisms how loss of retinal homeostasis evokes an unbalanced retinal immune reaction involving responses of local microglia and recruited macrophages, activity of the alternative complement system, and inflammasome assembly in the retinal pigment epithelium. Presenting these key mechanisms as complementary targets, we specifically emphasize the concept of immunomodulation as potential treatment strategy to prevent or delay vision loss. Promising molecules are ligands for phagocyte receptors, specific inhibitors of complement activation products, and inflammasome inhibitors. We comprehensively summarize the scientific evidence for this strategy from preclinical animal models, human ocular tissue analyses, and clinical trials evolving in the last few years.

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“…The HRS might be precursors of hard exudates but they can also be seen independently without the formation of hard exudates. 27,28 In previous studies, HRS have shown to be involved in the refractory DMO. 7 Furthermore, as seen in the previous studies, the decrease in the number of HRS seen in this study after dexamethasone treatment suggests that HRS might be inflammatory.…”

Section: Discussionmentioning

confidence: 96%

<p>Real Life Experience of Dexamethasone Implant in Refractory Diabetic Macular Oedema</p>

Karttunen

Nummelin

Kinnunen

2019

OPTH

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The purpose of this retrospective study was to examine the efficacy of dexamethasone implant in refractory diabetic macular oedema (DMO) in real life settings. Methods: In all, 24 eyes of 22 patients that required treatment with single or multiple intravitreal dexamethasone implants for refractory DMO were included in the study. Patients having macular oedema for another retinal disease were excluded from the study. The patient data were collected and analyzed retrospectively. As a demographic data age, gender, the type of diabetes and the duration of DMO were collected. Changes in central foveal thickness and the number of hyper reflective spots (HRS) were analyzed with Heidelberg SD-OCT. Furthermore, the best-corrected visual acuity (BCVA) and changes in the intraocular pressure (IOP) were measured. Results: In all, 50.0% of the eyes with baseline BCVA 0.45 (±2.4) lines in ETDRS LogMAR scale received only one implant during the follow-up of 332 (±79) days. At the end of the follow-up, BCVA was 0.26 (±2.0) lines. The other 50.0% of the eyes with baseline BCVA 0.64 (±3.0) lines received the second implant in 156 (±38) days. Central retinal thickness (CRT) at baseline was 333 (±44) μm in the eyes with only one implant and 497 (±125) μm in the eyes with 2 or more implants. IOP lowering medication was needed for 8.3% of the eyes. The decrease in the number of HRS was significant (8±17, p=0.048) in response to dexamethasone implantation. Conclusion: The dexamethasone implant is a useful treatment in refractory DMO and HRS seen in the OCT might indicate inflammation in the retina.

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Multimodality analysis of Hyper-reflective Foci and Hard Exudates in Patients with Diabetic Retinopathy

Cited by 32 publications

References 32 publications

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

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

Modulation of three key innate immune pathways for the most common retinal degenerative diseases

<p>Real Life Experience of Dexamethasone Implant in Refractory Diabetic Macular Oedema</p>

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