Fear of hypoglycaemia and parent sleep disturbance in families of young children with type 1 diabetes.

Diabetic retinal disease (DRD) is a progressive complication of diabetes mellitus (DM) and traditionally characterized by funduscopic microvascular abnormalities such as microaneurysms, hemorrhages, and vascular leakage on fluorescein angiography. However, current evidence suggests that neuroinflammatory processes may precede and potentially contribute to subsequent microvascular dysfunction of the neurovascular unit. Among the structural features visualized on optical coherence tomography (OCT), hyperreflective spots (HRSs) and hard exudates (HEs) have gained particular attention as clinically accessible biomarkers that may reflect distinct components of this neurovascular pathology. HRSs, typically identified on spectral-domain OCT (SD-OCT) as small (<30 µm), round dots with reflectivity comparable to the retinal nerve fiber layer (RNFL), are believed to represent activated microglia or other inflammatory by-products and are recognized as early indicators of neuroinflammation. HRSs are localized in the inner retina in a ramified state and gain motility as DRD develops and move toward the outer retina, as visualized by increased axial resolution OCT and adaptive optics–OCT in . In contrast, HEs, defined as larger (>30 µm) extravascular aggregations of lipids and lipoproteins with back shadowing on OCT and reflectivity similar to the retinal pigment epithelium (RPE), are thought to originate from chronic vascular leakage due to breakdown of the inner blood–retinal barrier. HEs are often located in the outer plexiform layer along the wall of inner retinal cysts, which is recognized as the “pearl necklace sign.” While both lesion types are frequently present in DRD, their topographical distribution, relationship to disease severity, and functional consequences remain incompletely understood. OCT/adaptive optics (AO)–OCT visualization of HRSs and HEs. () Increased axial resolution spectral-domain OCT B-scan of a 49-year-old male patient with nonproliferative diabetic retinopathy (NPDR), illustrating a representative HRS () within the outer nuclear layer and an HE () located in the outer plexiform layer. () AO-OCT en face image of a 39-year-old male patient with NPDR demonstrating a hyperreflective cellular structure consistent with an individual activated microglial cell. () Three-dimensional reconstruction of the single retinal microglial cell acquired by AO-OCT, revealing a central soma with irregular, branching processes.