Abstract：
BACKGROUND: Objectives of the study were to describe the hyperreflective foci (HRF) on optical coherence tomography angiography in diabetic macular edema (DME) with subretinal fluid (SRF) and explore the association of HRF in the outer retina with photoreceptor integrity and visual outcomes after anti-vascular endothelial growth factor (anti-VEGF) treatment.
METHODS: We retrospectively reviewed 46 eyes (36 patients) with DME treated with anti-VEGF drugs. The following parameters, including best-corrected visual acuity (BCVA), central macular thickness (CMT), the height of SRF, the number of HRF in the superficial capillary plexus, deep capillary plexus, and the outer retina, as well as the integrity of external limiting membrane (ELM) and ellipsoid zone (EZ), were evaluated and compared between the baseline and after 2 monthly injections of anti-VEGF drugs. The relationship between the HRF in the outer retina and the integrity of ELM and EZ, as well as BCVA, was analyzed.
RESULTS: BCVA was significantly improved in DME after anti-VEGF treatment; however, for the subgroup of DME patients with SRF, visual acuity remained unchanged after anti-VEGF treatment (p < 0.05 vs. p = 0.375). The number of HRF (p < 0.05), CMT (p < 0.001), and SRF height (p < 0.001) were significantly reduced, accompanied with partial restoration of ELM and EZ integrity after anti-VEGF injection. The HRF in the outer retina was correlated with the final ELM (p = 0.036) and EZ (p = 0.004) status. The final BCVA was significantly better in eyes with intact ELM (p = 0.002) and EZ at final visit (p < 0.001).
CONCLUSIONS: The number of HRF in outer retina was negatively associated with the microstructural restoration of ELM and EZ, as well as the visual outcome in DME patients with SRF after anti-VEGF treatment.
METHODS: We retrospectively reviewed 46 eyes (36 patients) with DME treated with anti-VEGF drugs. The following parameters, including best-corrected visual acuity (BCVA), central macular thickness (CMT), the height of SRF, the number of HRF in the superficial capillary plexus, deep capillary plexus, and the outer retina, as well as the integrity of external limiting membrane (ELM) and ellipsoid zone (EZ), were evaluated and compared between the baseline and after 2 monthly injections of anti-VEGF drugs. The relationship between the HRF in the outer retina and the integrity of ELM and EZ, as well as BCVA, was analyzed.
RESULTS: BCVA was significantly improved in DME after anti-VEGF treatment; however, for the subgroup of DME patients with SRF, visual acuity remained unchanged after anti-VEGF treatment (p < 0.05 vs. p = 0.375). The number of HRF (p < 0.05), CMT (p < 0.001), and SRF height (p < 0.001) were significantly reduced, accompanied with partial restoration of ELM and EZ integrity after anti-VEGF injection. The HRF in the outer retina was correlated with the final ELM (p = 0.036) and EZ (p = 0.004) status. The final BCVA was significantly better in eyes with intact ELM (p = 0.002) and EZ at final visit (p < 0.001).
CONCLUSIONS: The number of HRF in outer retina was negatively associated with the microstructural restoration of ELM and EZ, as well as the visual outcome in DME patients with SRF after anti-VEGF treatment.
摘要：
背景：描述糖尿病性黄斑水肿（DME）伴视网膜下液（SRF）的光学相干断层扫描血管造影（OCTA）上的高反射灶（HRF），并探讨抗血管内皮生长因子（anti-VEGF）治疗后外视网膜中HRF与感光体完整性和视觉效果的关系。
方法：我们回顾性分析了46例（36例）DME患者用抗VEGF药物治疗。以下参数，包括最佳矫正视力（BCVA），黄斑中心厚度(CMT),视网膜下液（SRF）的高度，浅表毛细血管丛（SCP）中HRF的数量，深毛细血管丛（DCP），和外视网膜，以及外界膜（ELM）和椭球区（EZ）的完整性，在基线和2个月注射抗VEGF药物后进行评估和比较。外视网膜中的HRF与ELM和EZ的完整性之间的关系，以及BCVA进行了分析。
结果：抗VEGF治疗后，DME的BCVA明显改善，然而,对于患有SRF的DME患者亚组，抗VEGF治疗后视力保持不变(p<0.05vs.p=0.375)。HRF的数量（p<0.05），CMT（p＜0.001），SRF高度显著降低(p＜0.001),抗VEGF注射后伴有部分ELM和EZ完整性恢复。外视网膜中的HRF与最终的ELM（p=0.036）和EZ（p=0.004）状态相关。在具有完整ELM(p=0.002)和最终就诊时EZ(p<0.001)的眼睛中,最终BCVA显著更好。
结论：外视网膜中HRF的数量与ELM和EZ的微观结构恢复呈负相关，以及抗VEGF治疗后伴有SRF的DME患者的视觉结果。
方法：我们回顾性分析了46例（36例）DME患者用抗VEGF药物治疗。以下参数，包括最佳矫正视力（BCVA），黄斑中心厚度(CMT),视网膜下液（SRF）的高度，浅表毛细血管丛（SCP）中HRF的数量，深毛细血管丛（DCP），和外视网膜，以及外界膜（ELM）和椭球区（EZ）的完整性，在基线和2个月注射抗VEGF药物后进行评估和比较。外视网膜中的HRF与ELM和EZ的完整性之间的关系，以及BCVA进行了分析。
结果：抗VEGF治疗后，DME的BCVA明显改善，然而,对于患有SRF的DME患者亚组，抗VEGF治疗后视力保持不变(p<0.05vs.p=0.375)。HRF的数量（p<0.05），CMT（p＜0.001），SRF高度显著降低(p＜0.001),抗VEGF注射后伴有部分ELM和EZ完整性恢复。外视网膜中的HRF与最终的ELM（p=0.036）和EZ（p=0.004）状态相关。在具有完整ELM(p=0.002)和最终就诊时EZ(p<0.001)的眼睛中,最终BCVA显著更好。
结论：外视网膜中HRF的数量与ELM和EZ的微观结构恢复呈负相关，以及抗VEGF治疗后伴有SRF的DME患者的视觉结果。
