University Eye Hospital Bern, Inselspital, Bern, Switzerland.
Invest Ophthalmol Vis Sci. 2012 Aug 24;53(9):5814-8. doi: 10.1167/iovs.12-9950.
Hyperreflective foci (HFs) are observable within the neurosensory retina in diabetic macular edema (DME) using spectral domain optical coherence tomography (SD-OCT). HFs have also been seen in wet age-related macular degeneration (AMD), although the origin is still unknown; however, they reduced significantly during anti-VEGF (vascular endothelial growth factor) therapy, and their baseline amount seemed to correlate with treatment success. In this study the behavior of HFs was evaluated during anti-VEGF therapy for DME.
Fifty-one patients (mean age: 67 years) underwent SD-OCT before and one month after one anti-VEGF injection (ranibizumab: n = 30; bevacizumab: n = 21). The HFs were semiquantitatively counted, assigned to three groups (group A: HFs n = 1-10; group B: n = 11-20; group C: n > 20), and correlated to the course of visual acuity and foveal thickness (paired t-test). Additionally the baseline HbA1c was categorized and correlated to baseline HFs (Spearman Rho).
In all eyes, HFs of various amounts were detected in the foveal and parafoveal area. The mean number of HFs reduced significantly from 16.02 to 14.32 in all patients (P = 0.000), whereas foveal thickness reduced from 445.5 to 373.9 μm (P = 0.000) and visual acuity increased from 62.0 to 66.0 ETDRS letters (P = 0.003). Regarding the three HF groups, a reduction of the level stages was observed in 43.1% (stable: 54.9%; more: 2.0%). This reflects a HF distribution change from 31.4% to 62.7% (group A), from 45.1% to 31.4% (group B), and from 23.5% to 5.9% (group C). The HbA1c correlated significantly to the overall HF amount at baseline (0.880; P = 0.000); however, no distinct overall correlation was found between the HF reduction and the course of visual acuity or retinal thickness. Only in cases of complete edema resolution (25%) did HFs reduce significantly (P = 0.008).
As in wet AMD, HFs are frequently found in DME and behave similarly under anti-VEGF therapy. Thus, a HF reduction was observable mainly in cases of complete edema resolution; however, no distinct correlation with visual acuity was noticed, presumably mainly due to the enhanced inhomogeneity in the disease progress of DME. Interestingly, the baseline HF amount seems to correlate positively with HbA1c values indicating the severity of disease.
在糖尿病性黄斑水肿（DME）中，使用谱域光相干断层扫描（SD-OCT）可观察到神经感觉视网膜中的高反射焦点（HFs）。在湿性年龄相关性黄斑变性（AMD）中也观察到了 HFs，尽管其来源仍不清楚；然而，它们在抗血管内皮生长因子（VEGF）治疗期间显著减少，并且它们的基线数量似乎与治疗成功相关。在这项研究中，评估了 DME 患者接受抗 VEGF 治疗期间 HFs 的行为。
51 名患者（平均年龄：67 岁）在一次抗 VEGF 注射前（雷珠单抗：n = 30；贝伐单抗：n = 21）和注射后一个月进行 SD-OCT。半定量计数 HFs，将其分为三组（A 组：HFs n = 1-10；B 组：n = 11-20；C 组：n > 20），并与视力和中心凹厚度的变化相关（配对 t 检验）。此外，还对基线 HbA1c 进行分类，并与基线 HFs 相关（Spearman Rho）。
在所有眼中，在中心凹和旁中心凹区域均检测到数量不等的 HFs。所有患者的 HFs 数量从 16.02 个显著减少到 14.32 个（P = 0.000），而中心凹厚度从 445.5 μm 减少到 373.9 μm（P = 0.000），视力从 62.0 提高到 66.0 ETDRS 字母（P = 0.003）。关于三个 HF 组，观察到水平阶段的减少在 43.1%（稳定：54.9%；更多：2.0%）。这反映了 HF 分布从 31.4%到 62.7%（A 组）、从 45.1%到 31.4%（B 组）和从 23.5%到 5.9%（C 组）的变化。HbA1c 与基线时的总 HF 数量显著相关（0.880；P = 0.000）；然而，视力或视网膜厚度的变化与 HF 减少之间没有明显的相关性。只有在完全水肿消退（25%）的情况下，HFs 才会显著减少（P = 0.008）。
与湿性 AMD 一样，HFs 在 DME 中也经常发现，并且在抗 VEGF 治疗下表现相似。因此，HF 的减少主要发生在完全水肿消退的情况下；然而，与视力没有明显的相关性，这可能主要是由于 DME 疾病进展的异质性增强。有趣的是，基线 HF 数量似乎与 HbA1c 值呈正相关，表明疾病的严重程度。
