Evaluation of the relationship between the number of hyperreflective spots and ıschemia parameters detected by optical coherence tomography in eyes with retinal vein occlusion

Abstract

Purpose: This study aimed to investigate the associations between hyperreflective dots (HRDs) and ischemia-related OCT biomarkers—specifically paracentral acute middle maculopathy (PAMM) and the prominent middle limiting membrane (p-MLM)—and to evaluate the relationship between HRDs and inflammatory markers in patients with retinal vein occlusion (RVO). Methods: This retrospective study included 40 eyes from 40 patients diagnosed with RVO. Comprehensive ophthalmologic examinations and spectral-domain optical coherence tomography (SD-OCT) were performed at baseline and after three intravitreal injections of bevacizumab. HRDs, PAMM, p-MLM, central macular thickness (CMT), external limiting membrane (ELM), and the integrity of the ellipsoid zone (EZ) were independently evaluated by two masked retina specialists. Statistical analyses were performed. Results: Inter-rater reliability was high for the assessment of HRDs, PAMM, and p-MLM. HRD counts showed a significant correlation with CMT and foveal depression. Higher HRD counts were observed in cases with serous macular detachment (SMD) compared to those without SMD. No significant association was found between HRDs and PAMM, p-MLM, or ELM defects. Conclusion: The findings of this study suggest that HRDs in RVO may be more closely linked to inflammatory processes rather than ischemia. While structural ischemia-related OCT biomarkers, such as PAMM and p-MLM, were not associated with HRD presence, their association with CMT and subretinal fluid may indicate an indirect relationship with inflammatory mechanisms. However, due to the study’s retrospective design and the relatively small sample size, these results should be interpreted cautiously. Larger, prospective studies are needed to clarify the underlying mechanisms and better define the relationship between HRDs, ischemia-related biomarkers, and inflammation.