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

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. 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. 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). 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.