Hyperreflective cystoid spaces in diabetic macular oedema: prevalence and clinical implications.

Aims: To analyse the prevalence and evolution of hyper-reflective cystoid spaces with decorrelation signal detected using optical coherence tomography angiography (OCTA) in diabetic macular oedema (DMO).
Methods: A retrospective study of consecutive eyes with DMO imaged using OCTA over a 1-year period was conducted. All eyes with hyper-reflective cystoid spaces at baseline and at least 3 months of follow-up were included in a longitudinal analysis.
Results: The prevalence of hyperreflective cystoid spaces with decorrelation signal was of 37% (61/165) in DMO eyes. Hyperreflective foci within hyperreflective cystoid spaces were observed in 85% of eyes. The longitudinal study included 33 eyes (10 observed and 23 treated with intravitreal anti-vascular endothelial growth factor), with a median follow-up of 15 months. The hyperreflective cystoid spaces resolved in 85% of eyes. The mean best-corrected visual acuity remained stable during the follow-up, even in the eyes achieving a resolution of the hyperreflective cystoid spaces. Hard exudates appeared in the area of resolved hyperreflective cystoid spaces in 33% of eyes.
Conclusion: Hyperreflective cystoid spaces detected by OCTA affected more than one-third of the DMO eyes. Their disappearance was not associated with any functional improvement and led to the formation of new hard exudate deposits in about one-third of the eyes.
Competing Interests: Competing interests: AC is a board member for Allergan (Ireland), Bayer HealthCare (Germany), Novartis Pharma (Switzerland) and has received travel grants from Allergan (Ireland) and Bayer HealthCare (Germany). RT is a board member for Alcon, Switzerland; Novartis, Switzerland; Roche, Switzerland; Allergan, USA; Bausch and Lomb, USA; Genentech, USA; Pfizer, USA; Alimera, USA; Bayer, Germany; FCI-Zeiss, France; Thrombogenics, Belgium, and consultant for Allergan, USA; DORC, Netherlands; Alcon, Switzerland; Novartis, Switzerland; Bausch and Lomb, USA; FCI-Zeiss, France; Thrombogenics, Belgium, has received lecture fees from Alcon, USA; Bausch and Lomb, USA; Novartis, Switzerland; Allergan, USA; Bayer, Germany; Alimera, USA, educational presentation fees from Bausch and Lomb, USA; Novartis, Switzerland; Zeiss, Germany; Sony, Japan; Alcon, Switzerland; Allergan, USA, meeting expenses from Novartis, Switzerland; Alcon, Switzerland; Allergan, USA; Bausch and Lomb, USA; Pfizer, USA; Bayer, Germany; DORC, Netherlands; Alimera, USA.
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