Association Between Hyperreflective Dots on Spectral-Domain Optical Coherence Tomography in Macular Edema and Response to Treatment

Hwang, Hye Seong; Chae, Ju Byung; Kim, Jin Young; Kim, Dong Yoon

doi:10.1167/iovs.17-22725

Cited by 76 publications

(83 citation statements)

References 41 publications

(52 reference statements)

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“…Hwang et al. () also found, in DME eyes resistant to three bevacizumab injections, that the presence of these kind of spots (from 20 to 40 μ m) at baseline is positively predictive for DEX response.…”

Section: Discussionmentioning

confidence: 93%

“…In our study, we considered as HRS only spots of size ranging between 20 and 40 lm which, according to Vujosevic represent activated microglial cells (Vujosevic et al 2016). Hwang et al (2017 also found, in DME eyes resistant to three bevacizumab injections, that the presence of these kind of spots (from 20 to 40 lm) at baseline is positively predictive for DEX response.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Dexamethasone for unresponsive diabetic macular oedema: optical coherence tomography biomarkers

Bonfiglio

Reibaldi

Pizzo

et al. 2018

Acta Ophthalmologica

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Purpose To analyse the effects of intravitreal dexamethasone implant (DEX) in patients with diabetic macular oedema (DME) unresponsive to ranibizumab treatment, in relation to the inflammatory optical coherence tomography (OCT) retinal features, subfoveal neuroretinal detachment (SND) and hyperreflective retinal spots (HRS). Methods Patients with DME poorly responsive to three injections of ranibizumab were treated with DEX. Best‐corrected visual acuity (BCVA) and central macula thickness (CMT, measured by Spectralis SD‐OCT) were assessed at baseline and at 1, 3, and 6 months. Results Overall, 44 eyes were included in the study. In the whole group, mean BCVA (baseline 51.5 ± 8.3 letters) increased significantly at 1 month (to 56.9 ± 8.8 letters; Tukey HSD p = 0.017) and was 55.5 ± 8.8 letters at 3 months (Tukey HSD p = 0.128). Central macula thickness (CMT) reduced significantly at 1 and 3 months (417 ± 149 μm and 469 ± 128 μm, respectively, both Tukey HSD p < 0.001 versus baseline). Subgroup analysis showed a significant BCVA increase at 1 month in eyes with SND + HRS (from 51.2 ± 9.2 to 58.2 ± 9.0, p = 0.029), and a trend to BCVA increase in eyes with HRS (from 52.3 ± 6.4 to 56.8 ± 7.9, p = 0.080), with a significant CMT decrease in both groups (p < 0.001). No changes of either parameter were found in eyes without SND and HRS. Conclusion Spectral domain OCT is useful in identifying some inflammatory features in DME. Among DME eyes ‘poorly responsive’ to ranibizumab, those with SND and HRS responded better to DEX implants than those without these features.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Dexamethasone for unresponsive diabetic macular oedema: optical coherence tomography biomarkers

Bonfiglio

Reibaldi

Pizzo

et al. 2018

Acta Ophthalmologica

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“…Larger number of HRS at week 48 were present in eyes with persistent macular oedema despite switching to aflibercept. Hwang et al reported HRS were associated with bevacizumab non‐responders significantly more than responders to treatment ( P < .001). A previous study by Turksever et al, reported on the reduction of HRS after switching from ranibizumab to aflibercept in eyes with neovascular AMD .…”

Section: Discussionmentioning

confidence: 99%

“…Hyperreflective spots are very small, round, well‐circumscribed, lesions, visible on OCT scans in the inner and outer retina that are equal to or with higher reflectivity than the RPE band . It has been hypothesized that HRS are activated macrophages or microglial cells . Presence and severity of HRS were evaluated within 1500 μm of the fovea on the horizontal scan passing through the foveal centre .…”

Section: Methodsmentioning

confidence: 99%

Prospective study of aflibercept for the treatment of persistent macular oedema secondary to retinal vein occlusions in eyes not responsive to long‐term treatment with bevacizumab or ranibizumab

Spooner

Fraser‐Bell

Hong³

et al. 2019

Clinical Exper Ophthalmology

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Importance: To examine the effect of switching from intravitreal bevacizumab or ranibizumab to aflibercept in eyes with persistent macular oedema due to retinal vein occlusion (RVO). Background: We report the results of a prospective interventional study on the effect of aflibercept 2 mg in eyes with persistent macular oedema after long-term treatment with bevacizumab or ranibizumab. Design: Non-randomized, prospective clinical trial. Participants: Eighteen eyes of eighteen patients were included.Methods: Eyes with persistent macular oedema despite a minimum of four previous intravitreal bevacizumab/ranibizumab injections were recruited into this 48-week trial. Three loading doses of intravitreal aflibercept were administered every 4-weeks, thereafter every 8-weeks until week 48. Main Outcome Measures: Mean change from baseline in best corrected visual acuity (BCVA) as measured by early treatment diabetic retinopathy score (ETDRS) and central macular thickness (CMT) as measured by spectral domain optical coherence tomography (SD-OCT) at 48 weeks. Results: Patients had received a mean of 40.0 ± 17.8 bevacizumab/ranibizumab intravitreal injections prior to switching to aflibercept. The mean number of previous injections administered in the 12-months preceding entry into the study was 10.2 ± 2.4. Mean vision change at week 48 was +21.1 ± 5.1 ETDRS letters in the BRVO group and +18.8 ± 5.9 letters at in the CRVO group (P < .001 for both groups). Mean decrease in CMT was 87.6 ± 48.8 μm and 191.0 ± 128.3 μm, in the BRVO and CRVO groups, respectively (P < .001). Using linear regression

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“…Eyes that responded poorly to bevacizumab were treated with dexamethasone implants. About 75% of such eyes showed a good response and corresponded to the eyes with a higher number of HRS [32]. Vujosevic and cols have also suggested that DME with a high number of HRS and a large area of increased foveal autofluorescence showed better morphologic and functional results (better retinal sensitivity) if, at least initially, was treated with intravitreal steroids versus anti-VEGF [28].…”

Section: Hyperreflective Retinal Spots (Hrs)mentioning

confidence: 96%

New Landmarks, Signs, and Findings in Optical Coherence Tomography

Lara-Medina¹,

Esteban²,

Bartolomé³

et al. 2019

A Practical Guide to Clinical Application of OCT in Ophthalmology

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Spectral domain optical coherence tomography (SD-OCT) is a common useful noninvasive imaging instrument which is used for the diagnosis and follow-up of macular disorders. The clinical findings by OCT in these pathologies are well known. Currently, due to the development of this technology and its wide use, new OCT findings have been reported in the literature. The aim of this chapter is to describe new pathological or abnormal signs and findings in SD-OCT, including hyperreflective spots or dots, flyer saucer sign, outer retinal tubulations, dipping sign, focal choroidal excavation, outer retina-choroid complex splitting, foveal pseudocyst, brush border pattern, dome-shaped macula, pearl necklace sign, choroidal macrovessel, cystoid foveal degeneration, and disorganization of the retinal inner layers (DRIL).

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Association Between Hyperreflective Dots on Spectral-Domain Optical Coherence Tomography in Macular Edema and Response to Treatment

Cited by 76 publications

References 41 publications

Dexamethasone for unresponsive diabetic macular oedema: optical coherence tomography biomarkers

Dexamethasone for unresponsive diabetic macular oedema: optical coherence tomography biomarkers

Prospective study of aflibercept for the treatment of persistent macular oedema secondary to retinal vein occlusions in eyes not responsive to long‐term treatment with bevacizumab or ranibizumab

New Landmarks, Signs, and Findings in Optical Coherence Tomography

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