HYPERREFLECTIVE RETINAL SPOTS IN EPIRETINAL MEMBRANES: Evolving Significance Across Disease Stages

To investigate the hyperreflective spots (HRS) across different stages of epiretinal membrane using optical coherence tomography and their relationship with anatomical and functional parameters.

This observational study included 111 patients with epiretinal membrane, categorized into early (Stages 1-2, n = 43) and late (Stages 3-4, n = 68). Total HRS (HRST), visual acuity, central retinal thickness, and outer nuclear layer thickness were measured using optical coherence tomography. Statistical analyses included Mann-Whitney U test for group comparisons and Spearman correlation to assess relationships between HRST and visual acuity.

Total hyperreflective spots increased significantly from early (27.67 ± 12.57) to late (35.15 ± 17.28, P = 0.015) stages. In early stages, HRST showed a moderate positive correlation with visual acuity (ρ = 0.48, P = 0.001), whereas this correlation diminished in late stages (ρ = 0.036, P = 0.426). Central retinal thickness also increased significantly from early to late stages (380.05 ± 94.51 µ m vs. 523.54 ± 83.92 µ m, P < 0.001). Outer nuclear layer thickness showed no significant difference between the stages ( P = 0.543). In early stages (Stage 1-2), linear regression model showed that HRST and central retinal thickness were valuable visual acuity predictors (Adjusted R 2 = 0.284, P < 0.05).

Total hyperreflective spots progressively increases with epiretinal membrane severity, correlating with visual function in early stages but losing this association in advanced stages. These findings suggest that HRST could be a prognostic marker for early disease progression and highlight the need for timely intervention to preserve visual function.