ERM: Hyperreflective Foci & OCTA

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Elevated hyperreflective foci are a newfound characteristic of idiopathic epiretinal membrane (iERM) we should be aware of. These foci were recently identified via optical coherence tomography angiography (OCTA) while studying changes in the retinal vitreous interface across different stages of iERM. Significant variations in the density and distribution of these foci were found among individuals with iERM at various stages of progression. Specifically, as developmental stages of iERM advanced, increasing hyperreflective foci density and distribution were apparent suggesting a close link between foci activation and aggregation and the specific stage of iERM development.

This observed pattern may support hyperreflective foci being indicators of inflammation, and thus potential biomarkers, offering us a simple and non-invasive method for associating the severity of inflammatory cells and debris across all stages of iERM. In addition, a potential link between increased hyperreflective foci counts and changes in retinal architecture was demonstrated which likely indicates greater risk of compromised vision. Finally, it was also shown positive correlations exist between hyperreflective foci and other key clinical findings such as posterior vitreous detachment (PVD), central macular thickness (CMT), and best-corrected visual acuity (BCVA).

Understanding hyperreflective foci as an inflammatory biomarker leads us down new avenues for understanding the pathophysiology of iERM - and may have significant implications for diagnosis and treatment approaches. This potential quantifiable marker of progression can only enhance our clinical decision-making, improve patient management, and of course long-term outcomes.

-JRM

Go to the article in BMC Ophthalmology HERE.

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