HYPERREFLECTIVE FOCI AS AN INDEPENDENT VISUAL OUTCOME PREDICTOR IN MACULAR EDEMA DUE TO RETINAL VASCULAR DISEASES TREATED WITH INTRAVITREAL DEXAMETHASONE OR RANIBIZUMAB.
OBJECTIVE
To evaluate the potential role of hyperreflective foci (HF) in predicting visual outcome in patients undergoing treatment for macular edema due to retinal vascular diseases.


METHODS
Data and images of 92 patients with macular edema due to diabetes mellitus or branch retinal vein occlusion, treated with either intravitreal dexamethasone implant or ranibizumab, were analyzed. All patients underwent best-corrected visual acuity measurement, slit-lamp examination, spectral domain optical coherence tomography at baseline and at all time points of the follow-up (Month 1, 2, 3, 6, and 9). Generalized least squares random effects linear or logistic regression analysis was used to investigate potential factors associated with the final best-corrected visual acuity and number of HF, respectively.


RESULTS
Increasing age (P < 0.001), central retinal thickness (P < 0.001), number of HF (P = 0.028), presence of subretinal fluid (P < 0.001), intraretinal fluid (P < 0.001), intraretinal cysts (P < 0.001), and disruption of ellipsoid zone/external limiting membrane (P < 0.001) were significantly associated with poorer visual outcome. Factors associated with HF were increasing central retinal thickness (P = 0.003), presence of subretinal fluid (P = 0.049), intraretinal fluid (P = 0.002), cysts (P = 0.015), and disruption of ellipsoid zone (P = 0.047). No significant differences in change in best-corrected visual acuity, central retinal thickness, and HF were observed between the two treatment groups.


CONCLUSIONS
Hyperreflective foci are associated with poorer visual outcome in patients with macular edema due to retinal vascular diseases. Similar reductions in HF are achieved by intravitreal steroid and anti-vascular endothelial growth factor agent.
*Laser and Retinal Research Unit, King's College Hospital, London, United Kingdom; †Department of Epidemiology and Biostatistics, University of Athens, Athens, Greece; and ‡NIHR Moorfields Biomedical Research Centre, London, United Kingdom.
Irini P
IP
Chatziralli
Theodoros N
TN
Sergentanis
Sobha
S
Sivaprasad
D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage*; D003930:Diabetic Retinopathy / Q000150:complications*; D005260:Female; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D058449:Intravitreal Injections; D008269:Macular Edema / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab / Q000008:administration & dosage*; D012170:Retinal Vein Occlusion / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D041623:Tomography, Optical Coherence; D014792:Visual Acuity
D020533:Angiogenesis Inhibitors; D005938:Glucocorticoids; D003907:Dexamethasone; D000069579:Ranibizumab