Abstract
Diabetic hyperreflective foci in the outer retinal layers are a clinically relevant finding on optical coherence tomography (OCT) images, although their characteristics remain to be elucidated. Here we investigated the decorrelation signal around hyperreflective foci on OCT angiography (OCTA) images in diabetic retinopathy (DR). We retrospectively reviewed sufficient quality OCTA images from 102 eyes of 66 patients that were obtained using split-spectrum amplitude-decorrelation angiography algorithm. Most confluent hyperreflective foci were randomly deposited or appeared in a radiating array on the en-face structural OCT images in the inner nuclear layer (INL) or Henle’s fiber layer (HFL), respectively. Within the INL, hyperreflective foci were not accompanied by decorrelation signals and attached to capillaries on OCTA images. Decorrelation signals were sometimes delineated in hyperreflective foci in the HFL and other times appeared to be pseudopod-like or wrapping around hyperreflective foci, referred to as reflectance-decorrelated foci. The decorrelation signal intensity of hyperreflective foci in the HFL was associated with logMAR VA (R = 0.553, P < 0.001) and central subfield thickness (R = 0.408, P < 0.001) but not with DR severity. These data suggest that reflectance-decorrelated foci on OCTA images are clinically relevant as well as shed lights on the properties in diabetic hyperreflective foci.
Highlights
Recent advances in optical coherence tomography angiography (OCTA) have enabled noninvasive evaluation of retinal vasculature[11,12,13]
We retrospectively reviewed the characteristics of hyperreflective foci on the structural OCT and OCT angiography (OCTA) images of 102 eyes of 66 patients with diabetic retinopathy (DR) after the exclusion of 44 eyes without hyperreflective foci in the inner nuclear layer (INL) and Henle’s fiber layer (HFL) (Fig. 1)
Three-dimensional OCT imaging demonstrated that hyperreflective foci were randomly deposited in the INL (Fig. 1E–G), whereas most lesions in the HFL appeared to be radiating toward the foveal center (Fig. 1H–J)
Summary
Recent advances in optical coherence tomography angiography (OCTA) have enabled noninvasive evaluation of retinal vasculature[11,12,13]. E.g., the nerve fiber layer, retinal pigment epithelium, ellipsoid zone of photoreceptors, and hyperreflective foci, are delineated on structural OCT images, it remains to be elucidated whether decorrelation signals are derived from such components[23]. (C, between green lines) and HFL (D, between red lines) on B-scan images with decorrelation signals along the arrows in panels G and J, respectively. (E–G) The 10-μm-thick en-face image in the INL between the green lines in panel C. (H–J) The 10-μm-thick en-face image in the HFL between the red lines in panel D. The OCT image reveals that most hyperreflective foci are deposited in a radiating fashion and are partly colocalized to the decorrelation signal on the OCTA image.
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