IRCCS - Fondazione Bietti, Rome, Italy.
Department of Ophthalmology, University of Padova, Padova, Italy.
Exp Eye Res. 2024 Oct;247:110020. doi: 10.1016/j.exer.2024.110020. Epub 2024 Aug 8.
Histopathologic studies of diabetic choroid suggest that diabetic choroidopathy is a key aspect secondary to diabetes. Recently, hyperreflective choroidal foci (HCF) have been introduced as novel optical coherence tomography (OCT) parameter. The aim of this study was to identify and quantify HCF in diabetic subjects with retinopathy, with or without diabetic macular edema (DME). Eighty-five diabetic subjects with different degrees of DR were enrolled: 37 without DME and 48 with DME. All subjects underwent full ophthalmologic examination including spectral domain optical coherence tomography (OCT). OCT images were analyzed to quantify and localize HCF. Each image was analyzed by two independent, masked examiners. OCT images showed that all subjects (100%) had HCF in the different layers of the choroid. The number of HCF was significantly higher in diabetics with DME versus those without DME (p < 0.0001). HCF showed variable size, shape and location inside the choroid. They were mainly located in choriocapillaris and Sattler's layer, on the edges of blood vessels. The intraobserver and interobserver agreement was almost perfect (ICC >0.9). This study suggests that hyperreflective foci in the choroid of subjects with DR may be accurately identified with structural OCT. Their number significantly increases with the progression of DME. These HCF may represent, as in the retina, a sign of infiltration of inflammatory cells (mainly migrating microglia) into the choroid, according to the hypothesis raised by Jerry Lutty. HCF may confirm in vivo the histopathologic findings suggesting that diabetic choroidopathy may be primarily a neuroinflammatory disorder.
糖尿病性脉络膜的组织病理学研究表明，糖尿病性脉络膜病变是继发于糖尿病的一个关键方面。最近，高反射性脉络膜病灶（HCF）已被引入作为新型光学相干断层扫描（OCT）参数。本研究的目的是在伴有或不伴有糖尿病性黄斑水肿（DME）的糖尿病患者中识别和量化 HCF。共纳入 85 名不同程度 DR 的糖尿病患者：37 名无 DME 和 48 名有 DME。所有患者均接受全面眼科检查，包括频域光学相干断层扫描（OCT）。对 OCT 图像进行分析以量化和定位 HCF。每个图像均由两名独立的、盲法检查者进行分析。OCT 图像显示，所有患者（100%）在脉络膜的不同层均存在 HCF。与无 DME 的糖尿病患者相比，有 DME 的糖尿病患者的 HCF 数量明显更高（p < 0.0001）。HCF 的大小、形状和位置在脉络膜内各不相同。它们主要位于脉络膜毛细血管和 Sattler 层，位于血管边缘。观察者内和观察者间的一致性几乎是完美的（ICC >0.9）。本研究表明，DR 患者脉络膜中的高反射性病灶可以通过结构 OCT 准确识别。随着 DME 的进展，其数量显著增加。根据 Jerry Lutty 提出的假说，这些 HCF 可能代表炎症细胞（主要是迁移的小胶质细胞）浸润脉络膜的迹象，就像在视网膜中一样。HCF 可能在体内证实组织病理学发现，即糖尿病性脉络膜病变可能主要是一种神经炎症性疾病。
