title: Association between hyperreflective foci in the outer retina, status of photoreceptor layer, and visual acuity in diabetic macular edema.
abstract: OBJECTIVE
  To determine if hyperreflective foci in the outer retina are associated with photoreceptor integrity and the logarithm of minimal angle of resolution (logMAR) visual acuity (VA) in patients with diabetic macular edema (DME).
  
  
  METHODS
  Retrospective, observational, cross-sectional study.
  
  
  METHODS
  Patients (n=76; 108 eyes) with clinically relevant macular edema and no serous retinal detachment were analyzed retrospectively. Spectral-domain optical coherence tomography (SD-OCT) images were obtained for all patients. We investigated the relationship between the hyperreflective foci in the outer retinal layers of the external limiting membrane (ELM) at the fovea and the photoreceptor integrity and VA.
  
  
  RESULTS
  SD-OCT showed that 58 eyes (53.7%) had hyperreflective foci in the outer retinal layers, and 107 eyes (99.1%) had hyperreflective foci in the inner retinal layers. The logMAR VA was significantly (P<.0001) worse in eyes with hyperreflective foci in the outer retinal layers than in eyes without them (0.463±0.382 vs 0.127±0.206, respectively). Disruption of the ELM line on OCT was significantly (P<.0001, for both comparisons) associated with both hyperreflective foci in the outer retinal layers and poor logMAR VA. Disruption of the junction of the inner and outer segment line (IS/OS) also was related to hyperreflective foci in the outer retinal layers and poor logMAR VA (P<.0001 for both comparisons).
  
  
  CONCLUSIONS
  The presence of hyperreflective foci in the outer retina is closely associated with a disrupted ELM and IS/OS line on SD-OCT images and decreased VA in DME.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan. akihito1@kuhp.kyoto-u.ac.jp
authors.forename: Akihito
authors.initials: A
authors.lastname: Uji
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Murakami
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Nishijima
authors.forename: Tadamichi
authors.initials: T
authors.lastname: Akagi
authors.forename: Takahiro
authors.initials: T
authors.lastname: Horii
authors.forename: Naoko
authors.initials: N
authors.lastname: Arakawa
authors.forename: Yuki
authors.initials: Y
authors.lastname: Muraoka
authors.forename: Abdallah A
authors.initials: AA
authors.lastname: Ellabban
authors.forename: Nagahisa
authors.initials: N
authors.lastname: Yoshimura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000473:pathology; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003930:Diabetic Retinopathy / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008269:Macular Edema / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020419:Photoreceptor Cells, Vertebrate / Q000473:pathology*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology*