Hyperreflective Foci and Disorganization of Retinal Inner Layers as Predictors of Visual Prognosis in Diabetic Macular Edema

Abstract

Background: Diabetic macular edema (DME) is a major cause of visual impairment, and optical coherence tomography biomarkers may help predict treatment outcomes. This study evaluated hyperreflective foci (HRF) and disorganization of retinal inner layers (DRIL) as predictors of visual prognosis in DME. Methods: This prospective observational study included 80 eyes with DME treated with intravitreal anti-VEGF therapy and followed for 6 months. Best-corrected visual acuity (BCVA), central macular thickness (CMT), HRF count, DRIL extent, and other OCT biomarkers were assessed. Multivariable regression and ROC analyses were performed. Results: Mean BCVA improved from 0.60 to 0.48 logMAR, while CMT decreased from 470.9 to 357.8 µm. DRIL extent showed a stronger correlation with 6-month BCVA than HRF count (r=0.699 vs 0.531). On multivariable analysis, DRIL extent, baseline BCVA, and ellipsoid-zone disruption independently predicted 6-month BCVA, whereas HRF count did not. DRIL showed an AUC of 0.829 for poor visual outcome. Conclusion: DRIL appears to be a stronger prognostic OCT biomarker than HRF in DME.