Choroidal Hyperreflective Foci: A Novel Spectral Domain Optical Coherence Tomography Biomarker in Eyes With Diabetic Macular Edema

Purpose: The aim of this study was to examine the hyperreflective dots seen in choroid on spectral domain optical coherence tomography (SDOCT) in eyes with diabetic macular edema (DME) and correlate it with visual acuity. Design: Consecutive, cross-sectional case series of patients with DME between January 2017 and December 2017. Methods: Eyes with DME having central foveal thickness >= 250 mu m were included. SDOCT was performed using Spectralis system (Heidelberg Engineering, Germany). Hyperreflective choroidal foci (HCF) were defined as well-circumscribed dots within choroid having reflectivity equal to or higher than adjacent retinal pigment epithelium. HCF were counted manually within 1500 mu m of fovea using a horizontal line scan by a blinded observer. Eyes were divided in 3 groups: group A (no HCF), group B (1-10 HCF), and group C (>10 HCF). Results: One hundred nineteen eyes of 60 DME patients were included. Sixty (50.4%) eyes were in group A, whereas 42 (33.6%) and 17 (14.2%) eyes belonged to group B and group C, respectively. The mean logMAR best corrected visual acuity was significantly lower in group B (0.76 +/- 0.79) and C (1.2 +/- 0.78) as compared with group A (0.22 +/- 0.49) (P = 0.001). Mean central foveal thickness in group A (300.4 +/- 122.4 mu m) was significantly lower than group B (455.52 +/- 209.1 mu m) and group C (529.4 +/- 196.4 mu m) with P value of 0.001. Conclusions: The present study describes HCF as novel prognostic SDOCT biomarker in DME whose presence denotes poor visual acuity. Further longitudinal studies are required to substantiate our findings.