The Prognostic Significance of Acute Henle Fiber Layer Hyperreflectivity in Placoid Diseases

Abstract

To investigate the pathophysiology and prognostic significance of acute Henle fiber layer (HFL) hyperreflectivity in placoid diseases by examining its relationship with impaired choroidal flow and persistent photoreceptor disruption. Retrospective-prospective observational study on patients with placoid diseases. Indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were performed during the acute phase and follow-up. Impaired choroidal flow, HFL hyperreflectivity, and persistent EZ disruption, their colocalization index, and their associations with initial and final visual acuity (VA) were explored. Sixteen eyes from 8 patients (mean age 25.3±6.44 years) were included (median follow-up 13.5 months). Quantitative analysis revealed significant correlations between areas of impaired choroidal flow, HFL hyperreflectivity, and persistent EZ disruption (correlation coefficients of 0.69, 0.63, and 0.46, respectively). Impaired choroidal flow area exceeded HFL hyperreflectivity (p=0.002) and EZ disruption (p=0.003). A noteworthy 94% non-random overlap between HFL hyperreflectivity and EZ disruption was observed. Worse initial VA correlated with foveal involvement (p=0.0002), thicker choroid (p=0.001), larger impaired choroidal flow areas (p=0.02), and thinner outer retina post lesion inactivation (p=0.04). HFL hyperreflectivity predicted photoreceptor recovery potential in placoid diseases. If HFL hyperreflectivity corresponds to acute HFL damage, it may suggest more severe involvement of the entire photoreceptor length.