Retinal Hyperreflective Foci in Type 1 Diabetes Mellitus

Schreur, Vivian; Breuk, Anita de; Venhuizen, Freerk G.; Sánchez, Clara I.; Tack, Cees J.; Klevering, B. Jeroen; Hoyng, Carel B.

doi:10.1097/iae.0000000000002626

Cited by 14 publications

(8 citation statements)

References 29 publications

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“…e amount of HRF reflects disease severity, exhibiting direct associations with HbA1c values and high levels of total cholesterol, triglycerides, and low-density lipoprotein [34][35][36][37]. e association with glycometabolic state has been observed even in early stages of diabetic retinopathy without DME, supporting the hypothesis of lipid extravasation conceivable in subjects with poor glycemic control [38,39].…”

Section: Clinical and Prognostic Implications Of Hyperreflective Foci In Diabetic Macular Edemamentioning

confidence: 84%

Significance of Hyperreflective Foci as an Optical Coherence Tomography Biomarker in Retinal Diseases: Characterization and Clinical Implications

Fragiotta

Abdolrahimzadeh

Dolz-Marco

et al. 2021

Journal of Ophthalmology

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Hyperreflective foci (HRF) is a term coined to depict hyperreflective dots or roundish lesions within retinal layers visualized through optical coherence tomography (OCT). Histopathological correlates of HRF are not univocal, spacing from migrating retinal pigment epithelium cells, lipid-laden macrophages, microglial cells, and extravasated proteinaceous or lipid material. Despite this, HRF can be considered OCT biomarkers for disease progression, treatment response, and prognosis in several retinal diseases, including diabetic macular edema, age-related macular degeneration (AMD), retinal vascular occlusions, and inherited retinal dystrophies. The structural features and topographic location of HRF guide the interpretation of their significance in different pathological conditions. The presence of HRF less than 30 μm with reflectivity comparable to the retinal nerve fiber layer in the absence of posterior shadowing in diabetic macular edema indicates an inflammatory phenotype with a better response to steroidal treatment. In AMD, HRF overlying drusen are associated with the development of macular neovascularization, while parafoveal drusen and HRF predispose to macular atrophy. Thus, HRF can be considered a key biomarker in several common retinal diseases. Their recognition and critical interpretation via multimodal imaging are vital to support clinical strategies and management.

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Section: Clinical and Prognostic Implications Of Hyperreflective Foci In Diabetic Macular Edemamentioning

confidence: 84%

Significance of Hyperreflective Foci as an Optical Coherence Tomography Biomarker in Retinal Diseases: Characterization and Clinical Implications

Fragiotta

Abdolrahimzadeh

Dolz-Marco

et al. 2021

Journal of Ophthalmology

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“…Like SDN, HRS have been suggested to represent activated aggregates of microglial cells and are also considered an imaging biomarker of retinal inflammatory response [27,28]. Additionally, the number of HRS has been associated with different stages of DR and DME severity [29]. The mean number of HRS was 66.4 ± 18.6 in Group 1, and 68.1 ± 19.8 in Group 2.…”

Section: Discussionmentioning

confidence: 99%

The Application of Structural Retinal Biomarkers to Evaluate the Effect of Intravitreal Ranibizumab and Dexamethasone Intravitreal Implant on Treatment of Diabetic Macular Edema

et al. 2020

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Background: The aim of this study was to compare the therapeutic effect of intravitreal treatment with ranibizumab and dexamethasone using specific swept-source optical coherence tomography retinal biomarkers in patients with diabetic macular edema (DME). Methods: 156 treatment-naïve patients with DME were divided in two groups: 75 patients received 3 monthly intravitreal injections of ranibizumab 0.5 mg (Lucentis®) (Group 1) and 81 patients received an intravitreal implant of dexamethasone 0.7 mg (Ozurdex®) (Group 2). Patients were evaluated at baseline (V1), at three months post-treatment in Group 1, and at two months post-treatment in Group 2 (V2). Best-corrected visual acuity (BCVA) and swept source-OCT were recorded at each interval. Changes between V1 and V2 were analyzed using the Wilcoxon test and differences between the two groups of treatment were assessed using the Mann–Whitney test. Multiple regression analysis was performed to evaluate the possible OCT biomarker (CRT, ICR, CT, SND, HRS) as predictive factors for final visual acuity improvement. Results: In both groups, BCVA improved (p-value < 0.0001), and a significant reduction in central retinal thickness, intra-retinal cysts, red dots, hyper-reflective spots (HRS), and serous detachment of neuro-epithelium (SDN) was observed. A superiority of dexamethasone over ranibizumab in reducing the SDN height (p-value = 0.03) and HRS (p-value = 0.01) was documented. Conclusions: Ranibizumab and dexamethasone are effective in the treatment of DME, as demonstrated by functional improvement and morphological biomarker change. DME associated with SDN and HRS represents a specific inflammatory pattern for which dexamethasone appears to be more effective.

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“…In the presence of HRF, not only CD14 but also Il-1β and IL-6 concentrations are increased, which underlines the inflammatory state in DME [ 8 , 60 , 110 ]. HRF are frequently found in the near vicinity of microaneurysms and intraretinal cysts [ 111 ], and not only at the retinal level but also in the choroid as a sign of advanced leakage activity [ 104 , 112 , 113 , 114 , 115 , 116 , 117 , 118 ]. The amount of HRF also represents a biomarker of disease severity in DR [ 109 , 110 , 111 , 112 ].…”

Section: Morphological Oct Biomarkers In Dmementioning

confidence: 99%

The Role of Intravitreal Corticosteroids in the Treatment of DME: Predictive OCT Biomarkers

Munk

Somfai

Smet

et al. 2022

IJMS

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This work aims to summarize predictive biomarkers to guide treatment choice in DME. Intravitreal anti-VEGF is considered the gold standard treatment for centers involving DME, while intravitreal steroid treatment has been established as a second-line treatment in DME. However, more than 1/3 of the patients do not adequately respond to anti-VEGF treatment despite up to 4-weekly injections. Not surprisingly, insufficient response to anti-VEGF therapy has been linked to low-normal VEGF levels in the serum and aqueous humor. These patients may well benefit from an early switch to intravitreal steroid treatment. In these patients, morphological biomarkers visible in OCT may predict treatment response and guide treatment decisions. Namely, the presence of a large amount of retinal and choroidal hyperreflective foci, disruption of the outer retinal layers and other signs of chronicity such as intraretinal cysts extending into the outer retina and a lower choroidal vascular index are all signs suggestive of a favorable treatment response of steroids compared to anti-VEGF. This paper summarizes predictive biomarkers in DME in order to assist individual treatment decisions in DME. These markers will help to identify DME patients who may benefit from primary dexamethasone treatment or an early switch.

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Retinal Hyperreflective Foci in Type 1 Diabetes Mellitus

Cited by 14 publications

References 29 publications

Significance of Hyperreflective Foci as an Optical Coherence Tomography Biomarker in Retinal Diseases: Characterization and Clinical Implications

Significance of Hyperreflective Foci as an Optical Coherence Tomography Biomarker in Retinal Diseases: Characterization and Clinical Implications

The Application of Structural Retinal Biomarkers to Evaluate the Effect of Intravitreal Ranibizumab and Dexamethasone Intravitreal Implant on Treatment of Diabetic Macular Edema

The Role of Intravitreal Corticosteroids in the Treatment of DME: Predictive OCT Biomarkers

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