The Comparison of Intracystic Hyperreflectivity in Different Macular Edema Etiologies. Is It a New Optical Coherence Tomography Biomarker?

OBJECTIVES: To detect the difference in internal hyperreflectivity of macular cystoid spaces in diabetic retinopathy (DR), exudative (wet) age-related macular degeneration (wet AMD), branch retinal vein occlusion (BRVO).
METHODS: The medical records of the consecutive patients who were followed up from Prof. Dr. Cemil Taşcıoğlu City Hospital, from 01 April 2023 to 01 June 2023, in the retina department, have been included in this study. The mean gray value (GV) and max-min GV parameters of the cystoid spaces which were detected in the spectral domain optical co-herence tomography (OCT) scans, were measured by using the ImageJ program (National Institutes of Health, Bethesda, Maryland, USA). The established diagnosis, baseline best corrected visual acuities (BCVA), OCT biomarkers such as serous macular detachment, hard exudate, hyperreflective foci and central macular thicknesses were also noted. The parameters were compared to each other regarding the different pathologies.
RESULTS: The mean-max GV of cystoid spaces and the mean-max GV of cystoid/vitreous ratio were found to be highest in the DR, followed by BRVO, and lowest in wet AMD (p<0.001 and p<0.001; respectively). Correlation analyses revealed a positive correlation between OCT biomarkers and intracystic hyperreflectivity (ICH) (p<0.001, respectively). Besides, the max GV cystoid/vitreous ratio is positively correlated with the BCVA (p<0.046; p=0.04, respectively).
DISCUSSION AND CONCLUSION: This pilot study investigates ICH in macular edema of various etiologies. The ICH was highest in the DR group, followed by the BRVO group, and lowest in the AMD group. It has been observed that there is a high correlation between ICH and OCT biomarkers. Findings support the hypothesis that ICH may reflect underlying inflammatory pro-cesses and contribute to individualized treatment approaches in retinal vascular pathologies.

Keywords: Branch retinal vein occlusion, diabetic maculopathy, diabetic retinopathy, intracystic hyperreflectivity, optical coherence tomography