title: Hyperreflective intraretinal spots in diabetics without and with nonproliferative diabetic retinopathy: an in vivo study using spectral domain OCT.
abstract: OBJECTIVE
  To evaluate the presence of hyperreflective spots (HRS) in diabetic patients without clinically detectable retinopathy (no DR) or with nonproliferative mild to moderate retinopathy (DR) without macular edema, and compare the results to controls.
  
  
  METHODS
  36 subjects were enrolled: 12 with no DR, 12 with DR, and 12 normal subjects who served as controls. All studied subjects underwent full ophthalmologic examination and spectral domain optical coherence tomography (SD-OCT). SD-OCT images were analyzed to measure and localize HRS. Each image was analyzed by two independent, masked examiners.
  
  
  RESULTS
  The number of HRS was significantly higher in both diabetics without and with retinopathy versus controls (P < 0.05) and in diabetics with retinopathy versus diabetics without retinopathy (P < 0.05). The HRS were mainly located in the inner retina layers (inner limiting membrane, ganglion cell layer, and inner nuclear layer). The intraobserver and interobserver agreement was almost perfect (κ > 0.9).
  
  
  CONCLUSIONS
  SD-OCT hyperreflective spots are present in diabetic eyes even when clinical retinopathy is undetectable. Their number increases with progressing retinopathy. Initially, HRS are mainly located in the inner retina, where the resident microglia is present. With progressing retinopathy, HRS reach the outer retinal layer. HRS may represent a surrogate of microglial activation in diabetic retina.
authors.affiliation: Department of Ophthalmology, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
authors.forename: Stela
authors.initials: S
authors.lastname: Vujosevic
authors.affiliation: Department of Ophthalmology, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bini
authors.affiliation: University Campus Biomedico, Via Alvaro del Portillo 21, 00128 Roma, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Midena
authors.affiliation: Department of Ophthalmology, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Berton
authors.affiliation: Department of Ophthalmology, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Pilotto
authors.affiliation: Department of Ophthalmology, University of Padova, Via Giustiniani 2, 35128 Padova, Italy ; Fondazione G.B. Bietti, Via Livenza 3, 00198 Roma, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Midena
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003930:Diabetic Retinopathy / Q000473:pathology*; D006801:Humans; D008269:Macular Edema / Q000473:pathology; D008875:Middle Aged; D012160:Retina / Q000473:pathology*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity