Hyperreflective Retinal Spots in Epiretinal Membranes: Evolving Significance Across Disease Stages.

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

Methods: This observational study included 111 patients with ERM, categorized into early (stages 1-2, n=43) and late (stages 3-4, n=68). Total Hyperreflective Spots (HRST), Visual Acuity (VA), central retinal thickness (CRT), and outer nuclear layer (ONL) thickness were measured using OCT. Statistical analyses included Mann-Whitney U test for group comparisons and Spearman's correlation to assess relationships between HRST and VA.

Results: HRST increased significantly from early (27.67 ± 12.57) to late stages (35.15 ± 17.28, p=0.015). In early stages, HRST showed a moderate positive correlation with VA (ρ=0.48, p=0.001), while this correlation diminished in late stages (ρ=0.036, p=0.426). CRT also increased significantly from early to late stages (380.05 ± 94.51 μm vs. 523.54 ± 83.92 μm, p<0.001). ONL thickness showed no significant difference between stages (p=0.543). Linear regression model showed in early stages (1-2) that HRST and CRT were valuable VA predictors (Adjusted R2=0.284, p < 0.05).

Conclusion: HRST progressively increases with ERM 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.