Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada.
Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Ophthalmol Retina. 2023 Dec;7(12):1087-1096. doi: 10.1016/j.oret.2023.07.016. Epub 2023 Jul 20.
To investigate hyperreflective dots (HRDs) on baseline OCT in rhegmatogenous retinal detachment (RRD).
Retrospective cohort study.
Consecutive primary fovea-off RRDs presenting between January 2012 and September 2022.
Visual acuity (VA) was obtained at baseline, 3, 6, and 12 months. Baseline foveal OCT scans were graded for the presence of HRDs in the outer retina, morphologic stage of RRD in the parafovea, and foveal photoreceptor integrity (intact, patchy or complete loss of the bacillary layer). Epiretinal membrane (ERM) and cystoid macular edema (CME) were graded after surgery.
The primary outcome was the proportion of patients in each morphologic stage with HRDs present on OCT and their association with postoperative VA. Secondary outcomes included association with the height of foveal detachment, duration of central vision loss, RRD extent, and development of ERM/CME.
A total of 351 patients were included. The presence of HRDs by morphologic stage of RRD was 0% in stage 1, 4.5% (2/42) in stage 2, 13% (7/54) in stage 3a, 16% (20/126) in stage 3b, 48% (40/83) in stage 4, and 85% (35/41) in stage 5. Hyperreflective dots were associated with increasing stage of RRD (P < 0.001), reduced integrity of foveal photoreceptors (P < 0.001), and reduced postoperative VA at 3, 6, and 12 months (P < 0.001), after excluding visually significant cataracts and adjusting for covariates. There was also a significant association between HRDs and height of foveal detachment, duration of central vision loss, and RRD extent (P < 0.001). Hyperreflective dots were neither associated with postoperative ERM formation nor with its severity (P = 0.27). Nevertheless, they were associated with the occurrence of CME at 3 and 6 months after surgery (P = 0.01; P = 0.006).
Hyperreflective dots have been hypothesized to consist of intraretinal inflammatory cells. We found that HRDs were significantly associated with the morphologic stage, extent, duration, and height of the RRD before surgery and with reduced VA and CME after surgery. Our results suggest that HRDs are associated with photoreceptor degeneration, as longstanding and extensive RRDs are more likely to present with HRDs. The association of HRDs with CME provides insight into the possible importance of inflammatory processes in RRD before and after surgery.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
研究孔源性视网膜脱离（RRD）患者基线 OCT 上的高反射点（HRD）。
回顾性队列研究。
2012 年 1 月至 2022 年 9 月连续出现的原发性黄斑区脱离的 RRD。
在基线、3 个月、6 个月和 12 个月时获得视力（VA）。对基线黄斑 OCT 扫描进行分级，以评估外层视网膜 HRD 的存在、旁黄斑区 RRD 的形态学分期以及黄斑感光细胞的完整性（完整、斑片状或全层光感受器丧失）。手术后评估视网膜内界膜（ERM）和囊样黄斑水肿（CME）。
主要结局是每个形态学分期的患者中存在 HRD 的比例及其与术后 VA 的关系。次要结局包括与黄斑脱离的高度、中央视力丧失的持续时间、RRD 范围以及 ERM/CME 的发展相关。
共纳入 351 例患者。RRD 形态分期中 HRD 的存在率为：1 期为 0%（42 例中 0 例），2 期为 4.5%（2/42 例），3a 期为 13%（7/54 例），3b 期为 16%（20/126 例），4 期为 48%（83 例中 40 例），5 期为 85%（41 例中 35 例）。HRD 与 RRD 分期的增加显著相关（P<0.001），与黄斑感光细胞完整性的降低显著相关（P<0.001），与术后 3、6 和 12 个月的 VA 降低显著相关（P<0.001），排除明显影响视力的白内障后，并进行了协变量调整。HRD 还与黄斑脱离的高度、中央视力丧失的持续时间和 RRD 范围显著相关（P<0.001）。HRD 与术后 ERM 形成及其严重程度均无显著相关性（P=0.27）。然而，HRD 与术后 3 个月和 6 个月时 CME 的发生显著相关（P=0.01；P=0.006）。
HRD 被假设为视网膜内炎症细胞。我们发现，HRD 与术前 RRD 的形态、范围、持续时间和高度以及术后 VA 和 CME 的降低显著相关。我们的结果表明，HRD 与光感受器变性有关，因为长期和广泛的 RRD 更可能出现 HRD。HRD 与 CME 的相关性提示在 RRD 术前和术后炎症过程可能很重要。
作者在本文中讨论的材料没有任何专有的或商业的利益。
