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Hyperreflective cystoid spaces in diabetic macular oedema: prevalence and clinical implications
  1. Aude Couturier,
  2. Valerie Mane,
  3. Carlo Alessandro Lavia,
  4. Ramin Tadayoni
  1. Universite de paris, Ophthalmology Department, AP-HP, Hôpital Lariboisière, F-75010, Paris, France
  1. Correspondence to Dr Aude Couturier, Ophthalmology, Universite de Paris UFR de Medecine Paris Nord, 75010 Paris, France; audecout{at}


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.

  • retina
  • imaging

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  • AC and VM contributed equally.

  • Contributors AC has contributed to the conception of the work, to the analysis and interpretation of data and has drafted the work. VM and CAL have contributed to the acquisition, analysis or interpretation of data, and have drafted the work and revised critically the final work. RT has contributed to the conception of the work, to the interpretation of data and has revised the work critically for important intellectual content.

  • Funding The Department of Ophthalmology received an independent research grant from Novartis Pharma SAS to study macular edema.

  • 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.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Deidentified participant data available. Contact: ORCID ID 0000-0001-8549-7455.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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