Hyper reflective foci on spectral domain optical coherence tomography as a biomarker for predict recurrent rate and visual prognosis in diabetes macular edema.

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Theinchai Pasurakul
Paiboon Bowornwattanadilok
Navapol Kanchanaranya
Nattapol Wongkumchang
Kittichai Akrapipatkul


Purpose: To investigate the correlation between the hyperreflective retinal foci and recurrent rate in diabetes patient after treatment with anti-VEGF

Methods: Review of medical records of 82 patients 101 eyes with diabetes macular edema between 2021 -2023 at Thammasat Hospital which had completed in medical record more than 24 month. We design study to compared recurrent and non recurrent macular edema group. Demographic data, such as age, gender, details of the underlying disease (HbA1c), including biomarkers such as Disorganization of retinal inner layer(DRIL), Hyper reflective retinal foci(HRF), Subretinal fluid(SRF), Intraretinal fluid(IRF) from OCT were collected at baseline.

Results : Hyperreflective retinal foci was notably more abundant in the recurrence group, exhibiting statistically significant disparities (P-value: 0.013). Furthermore, a substantial discrepancy emerged concerning HBA1C levels, with values of 7.5 ± 1.4 in the non-recurrence group and 8.9 ± 2.3 in the recurrence group (P-value: 0.044). Upon a 24-month evaluation, the visual acuity (log MAR) measured at 0.363 ± 0.482 in the non-recurrence group and 0.527 ± 0.206 in the recurrence group, manifesting a notable difference (P-value: 0.033). Hyperreflective retinal foci in the outer retina were markedly more prevalent in the recurrence group compared to the alternative group (P-value: 0.026). Furthermore, the mean count of anti-VEGF injections stood at 10.54 ± 2.58 in the non-recurrence group and 17.82 ± 1.93 in the recurrence group, displaying a statistically significant divergence (P-value: 0.041).

Conclusions : HRF in the outer retina displayed a favorable impact on visual prognosis and a tendency towards recurrence in cases of diabetic macular edema. Furthermore, Hemoglobin A1C emerged as a noteworthy risk factor deserving attention to attain optimal treatment outcomes.

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Original Study


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