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. 2023 Jul 17;23(1):324.
doi: 10.1186/s12886-023-03060-7.

Semi-automated quantification of vitreal hyperreflective foci in SD-OCT and their relevance in patients with peripheral retinal breaks

P Strzalkowski  1   2 , A K Schuster  3 , A Strzalkowska  4   3 , J S Steinberg  5 , S Dithmar  5
Affiliations

Semi-automated quantification of vitreal hyperreflective foci in SD-OCT and their relevance in patients with peripheral retinal breaks

P Strzalkowski et al. BMC Ophthalmol. .

Abstract

Background: Retinal breaks (RB) are emergencies that require treatment to prevent progression of rhegmatogenous retinal detachment. Vitreal hyperreflective foci (VHF) representing migration of RPE cell clusters or interphotoreceptor matrix from the RB are potential biomarkers. The aim of this study is to investigate VHF in RB-patients using SD-OCT.

Methods: The retrospective cross-sectional study included RB patients from our Department of Ophthalmology, HSK Wiesbaden who underwent macular SD-OCT (SPECTRALIS®, Heidelberg Engineering, Germany) on both eyes. VHF, defined and quantified as foci that differ markedly in size and reflectivity from the background speckle pattern, were assessed for presence and frequency. The RB-affected eyes were the study group (G1), the partner eyes the control group (G2).

Results: 160 consecutive patients with RB were included. Age was 60 ± 10.2 years (52% female). 89.4% of G1 and 87.5% of G2 were phakic (p = 0.73). 94.4% (n = 151) were symptomatic. Symptom duration was 8.0 ± 10.1 days in G1, 94.4% (n = 151) showed VHF versus 5.6% (p < 0.0001) in G2, of which 75% (n = 6) showed asymptomatic lattice degenerations. Detectable VHF showed a strong association of OR = 320 (95% CI, 110-788, p < 0.0001)) with respect to symptomatic RB. Sensitivity and specificity were 94.7% and 94.7%, respectively.

Conclusions: Most eyes with symptomatic RB show vitreal VHF in SD-OCT. Detected VHF are strongly associated with RB, and our semi-automated greyscale reflectivity analysis indicates that VHF likely originate from photoreceptor complexes torn out of the RB area that migrate into the vitreous cavity. The presence of VHF may indicate RB and should lead to a thorough fundus examination in both symptomatic and asymptomatic cases.

Keywords: OCT biomarker; Retinal break; SD-OCT; Semi-automated quantification; Vitreal hyperreflective foci; Vitreoretinal disorders.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Standard macular OCT scan of a right eye with infrared image (left side) and B-scan (right side). VHF are exemplarily marked with white arrows on the B-scan
Fig. 2
Fig. 2
Measurement of grey values with annotation of vitreal hyperreflective foci (VHF), vitreous cavity (VC), retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), external limiting membrane (ELM), photoreceptor layer (PR), retinal pigment epithelium/Bruch membrane complex (RPE/BM) and choroidal stroma (CS) and the corresponding ROI in an 8-bit greyscale OCT scan. The VHF is indicated by the arrow in the OCT scan
Fig. 3
Fig. 3
Difference in mean greyscale values and standard deviation between the reference point vitreal hyperreflective foci (VHF), vitreous cavity (VC), retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), external limiting membrane (ELM), photoreceptor layer (PR), retinal pigment epithelium/Bruch membrane complex (RPE/BM) and choroidal stroma (CS) (n = 20)
Fig. 4
Fig. 4
Comparison of refraction (dpt) in relation to VHF frequency
Fig. 5
Fig. 5
Correlation between refraction (dpt) and VHF frequency
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