OCT Academy

OCT Mastery - Tip of the previous week

257. Hyperreflective Lesions in Middle Retina

Sanjay Sharma
Sanjay Sharma
MD, MSc (Epid), MBA
Professor of Ophthalmology, Queen's University

OCT Tip 257 was originally published on January 20th, 2023.

This patient recently presented with blurred vision. Why?

Tip #253


In this image there are a series of hyperreflective lesions at the outer plexiform/outer nuclear junction. In addition, there are numerous dark cystic spaces. There is some loss of the ellipsoid area. The patient have scattered intraretinal hemorrhages and exudate on exam (video) in addition to capillary dropout on OCTA.

The patient was recently diagnosed with diabetic macular edema.

In this tip's accompanying 8 min. video, we'll review:

  • Review a differential diagnosis of macular edema
  • Review which layers predict poor vision
  • What lesions appear white on the retina
Tip #253 Analysis


In a patient with CME, always perform an examination of the retinal vasculature (including the periphery) to rule out a vascular lesion.

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