ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Clinical Diabetes
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1648828
This article is part of the Research TopicPrevention and Treatment Advancements in Diabetic RetinopathyView all 20 articles
Predictive Value of Hyperreflective Foci for Anti-VEGF Therapeutic Outcomes in Different Subtypes of Diabetic Macular Edema: A Retrospective Analysis
Provisionally accepted
- Department of Ophthalmology, Shandong Provincial Hospital, Jinan, China
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Objective To analyze the correlation between optical coherence tomography (OCT) biomarkers and therapeutic outcomes in patients with different subtypes of diabetic macular edema (DME) following anti-VEGF treatment. Methods This study conducted a retrospective analysis of 113 DME patients treated with anti-VEGF therapy. Based on OCT features, they were categorized into three groups: CME, DRT, and SRD. Primary outcomes included BCVA, CMT, and number of HRF during follow-up; secondary outcomes involved baseline OCT biomarkers such as DRIL and IS/OS disruption. The correlation between HRF, CMT, and BCVA was also analyzed. Results The CME group had the worst BCVA (LogMAR) throughout (vs. DRT/SRD, all P<0.05). For HRF, the DRT group had the fewest HRF across retinal layers throughout (e.g., inner retina: 1.91 ± 1.22 at 12 months, ANOVA P<0.001; post-hoc: DRT vs. CME P<0.001, DRT vs. SRD P<0.001). The CME group exhibited the great reduction in HRF (inner retinal layer: -2.53±2.14 vs. -1.07±1.44 in DRT, P=0.001; -2.36±2.34 in SRD, P=0.457) but recurrence at 6 months (351.78±110.93 μm at 6 months vs. 330.03±94.94 μm at 3 month). The SRD group maintained the highest HRF number, especially in outer retina (e.g., outer retinal layer: 1.97±1.81 at 12 months vs. 0.66±0.99 in DRT, P<0.001; 1.47±0.97 in CME, P=0.109). The DRT group had the lowest CMT at baseline (ANOVA P<0.001; post-hoc: DRT vs. CME P<0.001, DRT vs. SRD P<0.001). At 6 months, differences were mainly between DRT and CME (ANOVA P=0.017; post-hoc: p=0.006). The SRD group showed the least CMT change from baseline to final follow-up (ANOVA P<0.001; post-hoc: DRT vs. CME P<0.001, DRT vs. SRD P<0.001). Binary logistic regression identified baseline CMT (β=0.012, 95%CI 1.000–1.024, P=0.043), inner HRF (β=–0.712, 95%CI 0.238–1.011, P=0.047), and outer HRF (β=–0.797, 95%CI 0.375–1.083, P=0.031) as independent predictors of visual prognosis. Conclusion Anti-VEGF therapy can reduce the number of HRF in the three subtypes of DME. Baseline HRF, especially within the inner and outer retinal layers, are useful prognostic markers for visual acuity. Subtype-specific treatment and monitoring approaches may enhance long-term visual prognosis in DME patients.
Keywords: diabetic macular edema, Diabetic Retinopathy, Hyperreflective foci, vascularendothelial growth factor, Optical Coherence Tomography
Received: 17 Jun 2025; Accepted: 30 Sep 2025.
Copyright: © 2025 Wang, Li, Hao, Kong and Weiyan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhou Weiyan, zhouweiyan5@163.com
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