Hyperreflective Dots: A New Spectral-Domain Optical Coherence Tomography Entity for Follow-Up and Prognosis in Exudative Age-Related Macular Degeneration

Coscas, G.; Benedetto, Umberto De; Coscas, Florence; Calzi, C. I. Li; Vismara, Sabrina; Roudot‐Thoraval, Françoise; Bandello, Francesco; Souied, Eric H.

doi:10.1159/000342159

Cited by 185 publications

(188 citation statements)

References 39 publications

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“…10 The origin of HF remains controversial, and activated microglia or lipoprotein exudation are among the suspected causes. 11,12 We hypothesized that sCD14 in the AH is derived from activated microglia in the diabetic retina, and that if the level of this cytokine is correlated with the number of HF on SD-OCT in DME patients, HF could be indicative of activated microglia in DME patients.The degree of microglia activation could vary according to the different types of DME: focal, diffuse, or combined. We speculated that the level of sCD14 and the distribution of HF could also differ depending on the type of DME because focal and diffuse edema appear to have different underlying pathophysiologies; diffuse edema is thought to result from disrupted retinal vessel integrity mainly in the inner retinal layer, whereas focal edema results from microaneurysms with pathology observed primarily in the outer retina.…”

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confidence: 99%

Association Between Soluble CD14 in the Aqueous Humor and Hyperreflective Foci on Optical Coherence Tomography in Patients With Diabetic Macular Edema

Lee

Jang

Choi

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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Citation: Lee H, Jang H, Choi YA, Kim HC, Chung H. Association between soluble CD14 in the aqueous humor and hyperreflective foci on optical coherence tomography in patients with diabetic macular edema. Invest Ophthalmol Vis Sci. 2018;59:715-721. https://doi.org/10.1167/ iovs. PURPOSE. To investigate the associations between soluble CD14 (sCD14), a cytokine released by microglia and macrophages, and hyperreflective foci (HF) and various characteristics of spectral-domain optical coherence tomography (SD-OCT) in diabetic macular edema (DME).METHODS. Sixty-nine eyes from 51 patients with DME and 28 eyes from 28 control subjects were studied. sCD14 levels in the aqueous humor (AH) were measured using ELISA before bevacizumab injection (IVB), and the associations between sCD14 and visual acuity, the number of HF, retinal volume, and the DME pattern were assessed.RESULTS. sCD14 levels were higher in DME patients than in the control subjects (29.9 6 41.6 pg/mL versus 8.1 6 3.6 pg/mL, P < 0.001). sCD14 levels in diffuse edema were higher than those in focal edema (50.0 6 65.3 pg/mL versus 19.8 6 14.7 pg/mL, P ¼ 0.039). The number of HF in the inner retina of patients with diffuse edema was significantly higher than that in patients with focal edema (4.4 6 2.3 vs. 2.6 6 2.1, P ¼ 0.001), but no difference was found in the outer retina (5.8 6 3.4 vs. 5.0 6 3.9, P ¼ 0.25). According to multivariate analyses, elevated sCD14 levels were associated with an increased inner nuclear layer volume and the total number of HF in all retinal layers on SD-OCT. Reduction of DME following IVB was correlated with reduction in the number of HF in a subset of eyes followed longitudinally in the study (n ¼ 30).CONCLUSIONS. DME patients with diffuse edema exhibit higher sCD14 levels in the AH and more HF in the inner retina than patients with focal edema, indicating severe inflammation. The strong correlation between sCD14 and HF in the inner retina suggests that the HF observed on SD-OCT may be due to activated microglia in DME.Keywords: CD14, hyperreflective foci, diabetic macular edema, diffuse edema type, focal edema type D iabetic macular edema (DME) is the most common cause of vision loss in diabetic retinopathy (DR).1 The disruption of blood-retinal barriers induces the influx of fluid into the retina, resulting in DME.2 Although the pathogenesis of DR is not fully elucidated, inflammatory reactions, including monocyte/macrophage recruitment and microglia activation, are considered among the causative factors of DME. 3CD14 is a cytokine associated with the innate immune response and is expressed in microglia, monocytes, and macrophages.4 CD14 exists in two forms: membrane-bound or soluble (sCD14) 5 ; both forms are related to the activation of the inflammatory response. 6 In DME, the levels of sCD14 are elevated in the aqueous humor (AH) and vitreous humor and are associated with increased levels of VEGF.7 Microglia are resident immune cells in the retina that are involved in the inflammatory changes underlying DR. In DR, microglia p...

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confidence: 99%

Association Between Soluble CD14 in the Aqueous Humor and Hyperreflective Foci on Optical Coherence Tomography in Patients With Diabetic Macular Edema

Lee

Jang

Choi

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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“…Hyperreflective spots or dots (HRD) are new findings previously unseen in OCT demonstrated firstly by Coscas et al [26]. The HRDs are scattered, punctiform, small in size, mainly located in the outer retinal layers.…”

Section: Discussionmentioning

confidence: 86%

“…It has been reported in the patients with CSCR. It has been demonstrated that HRDs in the patients with CSCR may be located as subretinal, intraretinal or at inner regions of the detached retina [13,17,26,27]. Although etiology of HRD is not clear, there are various theories of the pathogenesis of HRD.…”

Section: Discussionmentioning

confidence: 99%

“…They might be caused focal accumulations of pigment or lipofuscin granules, small intraretinal proteins or lipid/lipoprotein exudates/deposits/extravasation due to the breakdown of the blood-retinal barrier, derived the degenerated photoreceptors or the macrophages phagocyted their outer segments. It has been suggested that HRD might be a marker of the inflammatory response or the breakdown of the blood-retina barrier [13,17,26,27]. OCT showed that HRDs accumulate at the posterior surface of the detached neurosensory retina in a vast majority of the patients with CSCR and that HRDs might have non-phagocyte-bearing rhodopsin and/or due to previous inflammatory mediators and/or dysfunctional RPE [28].…”

Section: Discussionmentioning

confidence: 99%

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Comparison of optical coherence tomography findings in males and females with acute central serous chorioretinopathy

Karanfil¹

2017

New Front Ophthalmol

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Objective: To compare the optical coherence tomography (OCT) findings in males and females with acute central serous chorioretinopathy (CSCR). Materials and methods:In this retrospective study, the OCT scans of 8 females (Group 1) and 16 males (Group 2) cases with acute CSCR which were diagnosed based on clinical, ophthalmological and OCT findings and which was followed in our hospital were retrospectively reviewed. The existence of the OCT findings and patterns regarding CSCR and sub-foveal choroidal thicknesses (SFCTs) were compared.Results: Serous macula detachment (SMD) was present in all of the female and male cases. The most common OCT finding was the brush-border pattern (6 cases, 75%) except SMD and retina pigment epithelium (RPE) bulging in females, and RPE bulging (14 cases, 87.5%) except SMD in males. There was no statistically significant difference in the frequency of OCT findings and patterns between both groups (p>0.05). The mean SFCTs of the eyes with CSCR in Group 1 and Group 2 were 346.08±32.1 µm (ranged from 338 to 365 µm) and 351.32±36.5 µm (ranged from 344 to 376 µm), respectively. The difference between SFCTs in the affected eyes was also not statistically significant (p>0.05).

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“…6) [11]. Авторы описали мелкие гиперрефлективные очажки во всех слоях сетчатки, но с преиму-щественным расположением в наружных слоях нейроэпителия и вблизи интраретинальных кист, а также предположили, что ГРТ являются след-ствием активации и скопления клеток микроглии [12]. Активация астроцитов при этом происходит вследствие повышения внутриклеточного содер-жания кальция под воздействием глутамата.…”

Section: клинический случайunclassified

Aflibercept treatment in patients with diabetic macular edema

Astakhov

Сергеевич²,

Nechiporenko

et al. 2017

Ophthalmology Reports

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The article provides a brief description of diabetic macular edema pathogenesis highlighting the role of inflammation, along with a short review of aflibercept trials in diabetic macular edema patients. Three clinical cases of diabetic macular edema treatment with aflibercept (Eylea) intravitreal injections in treatment-naïve patients are described; therapy was performed for 1 year according to the scheme provided in the Summary of Product Characteristics.

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Hyperreflective Dots: A New Spectral-Domain Optical Coherence Tomography Entity for Follow-Up and Prognosis in Exudative Age-Related Macular Degeneration

Cited by 185 publications

References 39 publications

Association Between Soluble CD14 in the Aqueous Humor and Hyperreflective Foci on Optical Coherence Tomography in Patients With Diabetic Macular Edema

Association Between Soluble CD14 in the Aqueous Humor and Hyperreflective Foci on Optical Coherence Tomography in Patients With Diabetic Macular Edema

Comparison of optical coherence tomography findings in males and females with acute central serous chorioretinopathy

Aflibercept treatment in patients with diabetic macular edema

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