摘要： We read with great interest the article titled ‘Association Between Soluble CD14 in the Aqueous Humor and Hyperre?ective Foci on Optical Coherence Tomography in Patients with Diabetic Macular Edema’ by Lee et al. The authors investigated the expression of soluble CD14 (sCD14) in aqueous humor (AH) samples of patients with diabetic macular edema (DME), and the presence of hyperre?ective foci (HF) on spectral-domain optical coherence tomography (SD-OCT) in these eyes. The authors found both higher levels of sCD14, and increased number of HF in the inner retina compared to controls, and concluded that, since sCD14 is released by retinal microglia, HF might represent aggregates of activated microglial cells in DME eyes. The presence of and changes in OCT HF, also called hyperre?ective spots, have been previously described in detail in diabetic eyes and reported to depend on activated microglia. DME-affected eyes treated with intravitreal anti-VEGF and steroids have also been investigated, demonstrating a reduction of HF number with both treatments—con?rming HF as a retinal in?ammatory biomarker. To improve this observation, we also investigated diabetic eyes in a large population to identify HF-speci?c characteristics, a topic not suf?ciently addressed by Lee et al. In particular, we disagree with the statement that HF, as aggregates of retinal microglial cells, have the same re?ectivity as the retinal pigment epithelium (RPE), whereas it is more similar to that of the retinal nerve ?ber layer (RNFL). Other clinical characteristics (size < 30 lm, absence of back-shadowing, presence in both inner and outer retinal layers in DME) allow differentiation of HF, as an in?ammatory biomarker, from hard exudates, small intraretinal hemorrhages, microaneurysms, and tiny capillaries, which also appear as OCT hyperre?ective foci (spots). The correct identi?cation of in?ammation-driven HF from other forms of hyperre?ective material is relevant when using this new biomarker in the follow-up of any DME treatment. As consequence, any investigation of HF on OCT in diabetic eyes should be more precise to avoid inconsistent results.