Correlation of hyperreflective foci, status of photoreceptor layer, and visual acuity in diabetic macular edema

Purpose To investigate the correlation ofhyperreflective foci, photoreceptor integrity and visual acuity (VA) in patients with diabetic macular edema (DME). Methods Seventy-eight patients (114 eyes) with DME were analyzed retrospectively with Spectral-domain optical coherence tomography (SD-OCT). Results SD-OCT showed that 28 eyes (24.5%) had hyperreflective foci in the inner retinal layers, and 66 eyes (57.9%) had hyperreflective foci in the outer retinal layers. The logMAR VA was significantly (P < .0001) worse in eyes with hyperreflective foci in the outer retinal layers than in eyes without them (0.478 ± 0.241 vs 0.133 ± 0.233, respectively). Disruption of the ellipsoid zone and ELM line on OCT were significantly (respectively P < .0001 and P < .0001) associated with both hyperreflective foci in the outer retinal layers and poor logMAR VA. Conclusions The presence of hyperreflective foci in the outer retina is closely associated with a disrupted ELM and ellipsoid zone on SD-OCT images and decreased VA in DME.