Optical coherence tomographic hyperreflective foci: a morphologic sign of lipid extravasation in diabetic macular edema.
OBJECTIVE
To analyze hyperreflective foci typically seen in diabetic macular edema (DME) in optical coherence tomography (OCT).


METHODS
Prospective clinical trial.


METHODS
Twelve consecutive patients with treatment-naïve, clinically significant DME.


METHODS
During a same-day examination, a standardized visual acuity assessment (Early Treatment of Diabetic Retinopathy Study protocol), infrared fundus imaging, color fundus photography, and biomicroscopy were performed. Additionally, all patients were scanned using Stratus, Cirrus, and Spectralis OCT and results correlated.


METHODS
Morphologic changes secondary to DME.


RESULTS
In all eyes with DME, distinct hyperreflective foci distributed throughout all retinal layers were found in the OCT scans of all 3 OCT devices. These deposits could not be identified by infrared imaging, fundus photography, or biomicroscopy as long as they were not confluent. Accumulations of such foci at the border of the outer nuclear and in the outer plexiform layer were recognizable clinically as hard exudates showing the same hyperreflective features in OCT. The hyperreflectivity of these foci did not correspond with intraretinal hemorrhage, nor did the lesions cause the characteristic OCT laser beam scattering phenomena typically seen secondary to intraretinal bleedings or microaneurysms. Further, they were detected within the walls of intraretinal microaneurysms.


CONCLUSIONS
Well-demarcated, hyperreflective foci were identified in the retina of patients with DME. The deposits were located within walls of intraretinal microaneurysms and scattered throughout all retinal layers, forming confluent plaques in the outer plexiform layer. It is suggested that the foci represent extravasated lipoproteins and/or proteins being a very early subclinical barrier breakdown sign in DME.
Bolz
Matthias
M
Department of Ophthalmology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria.
Schmidt-Erfurth
Ursula
U
Deak
Gabor
G
Mylonas
Georgios
G
Kriechbaum
Katharina
K
Scholda
Christoph
C
D000368:Aged; D000369:Aged, 80 and over; D001826:Body Fluids / Q000378:metabolism*; D003930:Diabetic Retinopathy / Q000378:metabolism* / Q000473:pathology; D005122:Exudates and Transudates; D006801:Humans; D050356:Lipid Metabolism; D008074:Lipoproteins / Q000378:metabolism*; D008269:Macular Edema / Q000378:metabolism* / Q000473:pathology; D033401:Microscopy, Acoustic; D008875:Middle Aged; D010781:Photography; D011446:Prospective Studies; D012160:Retina / Q000378:metabolism; D041623:Tomography, Optical Coherence; D014792:Visual Acuity
D008074:Lipoproteins