Hyperreflective Material Serves As a Potential Biomarker of Dyslipidemia in Diabetic Macular Edema.

Purpose: The aim of this study was to investigate the vision-affected optical coherence tomography (angiography) (OCT/OCTA)-based morphological characteristics of diabetic macular edema (DME) and to explain their possible underlying mechanisms from a systemic perspective. Methods: Diabetic patients with DME were included in this retrospective study. The clinical profiles and OCT/ OCTA morphological characteristics were recorded. Linear mixed-model analyses were performed between bestcorrected visual acuity (BCVA) and each OCT/OCTA morphological characteristic. Linear and logistic mixedmodel analyses were performed between each vision-affected morphological characteristic and the clinical characteristics. Results: Eighty-five eyes of 85 patients were included. The number of hyperreflective dots (HDs) (p<0.001) and hyperreflective foci (HF) (p = 0.006) was positively correlated with LogMAR BCVA in the univariate analysis. The number of HDs (p = 0.008) remained correlated with LogMAR BCVA in the multivariate analysis. Eyes with an increased number of HF (p = 0.01) were more likely to have hard exudates within a fovea area diameter of 3 mm, while the relationship between the number of HDs and the presence of hard exudates did not reach significance. In the multivariate analysis, the increased level of total cholesterol (TC) (p = 0.004) and the reduced level of serum albumin (p = 0.014) were associated with an increased number of HDs, and the level of serum TC (p = 0.039) was positively associated with the number of HF. Conclusion: Hyperreflective material may be a predictor for BCVA and serves as a potential biomarker of dyslipidemia in DME. It was postulated that HF are mainly related to hard exudates and HDs are partially associated with microglial cell activation.