title: Hyperreflective foci in outer retina predictive of photoreceptor damage and poor vision after vitrectomy for diabetic macular edema.
abstract: OBJECTIVE
  To investigate the correlation between visual outcomes and preoperative hyperreflective foci in the outer retinal layers seen on spectral domain optical coherence tomography images in eyes that underwent vitrectomy for diabetic macular edema.
  
  
  METHODS
  We retrospectively reviewed 32 consecutive eyes that underwent vitrectomy for diabetic macular edema. Ten eyes had accumulated or many hyperreflective foci in the outer retinal layers preoperatively; 22 eyes did not have the pathology. The logarithm of the minimum angle of resolution and the junction between inner and outer segments were studied in the groups.
  
  
  RESULTS
  Logarithm of the minimum angle of resolution was significantly better in eyes without hyperreflective foci than in those with hyperreflective foci at 3 months and 6 months, and the last visit (P = 0.029, 0.010, and <0.001, respectively) compared with no differences at the baseline. Visual improvement was greater in eyes with no hyperreflective foci at the same time points. Seven eyes with hyperreflective foci had no junction between inner and outer segments at the final visit, whereas only 4 eyes with no foci had no junction between inner and outer segments (P = 0.004). However, the foveal thickness did not differ between the groups at any time.
  
  
  CONCLUSIONS
  Preoperative hyperreflective foci in the outer retinal layers detected by spectral domain optical coherence tomography might predict the photoreceptor damage and a poorer prognosis after vitrectomy for diabetic macular edema.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Nishijima
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Murakami
authors.forename: Takako
authors.initials: T
authors.lastname: Hirashima
authors.forename: Akihito
authors.initials: A
authors.lastname: Uji
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: Ueda-Arakawa
authors.forename: Yuki
authors.initials: Y
authors.lastname: Muraoka
authors.forename: Nagahisa
authors.initials: N
authors.lastname: Yoshimura
mesh_terms: D003930:Diabetic Retinopathy / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008269:Macular Edema / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D012164:Retinal Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D055214:Retinal Photoreceptor Cell Outer Segment / Q000473:pathology*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014786:Vision Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy