Vitreous hyper-reflective dots in pseudophakic cystoid macular edema assessed with optical coherence tomography

PLoS One. 2017 Dec 15;12(12):e0189194. doi: 10.1371/journal.pone.0189194. eCollection 2017.


Purpose: This study compares the presence of vitreous hyper-reflective dots (VHDs) detected with optical coherence tomography (OCT) between eyes with pseudophakic cystoid macular edema (CME) and those with no CME after cataract surgery. In addition, we evaluated the impact of VHDs on the responsiveness of pseudophakic CME to cortisone treatment.

Setting: Department of Ophthalmology, Medical University of Graz, Austria.

Design: Retrospective, monocenter case-controlled study.

Methods: Inclusion criteria for the study group and the control group were CME and no CME within 12 weeks following uneventful phacoemulsification in otherwise healthy eyes, respectively. VHDs (number and size) and the macular thickness were assessed with OCT. Furthermore, the number of peribulbar or intravitreal steroid injections was assessed.

Results: A total of 284 eyes from 267 patients were analyzed, among which 119 met the inclusion criteria for the study (n = 63) and the control group (n = 56). VHDs were observed in 54 (85.7%) study eyes and 21 (37.5%, p = 0.013) control eyes. The number of VHDs was 3.9±3.4 in the study group and 0.7±1 in the control group (p<0.001). The size of the VHDs was 33.5±9.1 μm and 36.6±17.9 μm in the study and control groups, respectively (p = 0.978). Overall, the number of VHDs correlated with central subfield thickness (r = 0.584, p<0.001), cube volume (r = 0.525, p<0.001), and postoperative best-corrected visual acuity (BCVA) (r = -0.563, p<0.001). The number of VHDs did not correlate with the frequency of peribulbar or intravitreal steroid injections.

Conclusion: VHDs occurred more often in eyes with CME than in eyes without CME following cataract surgery. In addition, the number of VHDs had an impact on the extent of macular thickening and subsequently postoperative BCVA. No correlation was found between the number of VHDs and the frequency of required peribulbar or intravitreal steroid injections.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Inflammatory Agents / therapeutic use
  • Case-Control Studies
  • Cataract / diagnostic imaging
  • Cataract / physiopathology
  • Cortisone / therapeutic use
  • Female
  • Humans
  • Intravitreal Injections
  • Macular Edema / diagnostic imaging*
  • Macular Edema / drug therapy
  • Macular Edema / physiopathology
  • Macular Edema / surgery
  • Male
  • Middle Aged
  • Phacoemulsification*
  • Postoperative Period
  • Pseudophakia / diagnostic imaging*
  • Pseudophakia / drug therapy
  • Pseudophakia / physiopathology
  • Pseudophakia / surgery
  • Retrospective Studies
  • Tomography, Optical Coherence
  • Visual Acuity / physiology
  • Vitreous Body / diagnostic imaging*
  • Vitreous Body / drug effects
  • Vitreous Body / surgery


  • Anti-Inflammatory Agents
  • Cortisone

Grant support

The author(s) received no specific funding for this work.