Occult macular dystrophy with bilateral chronic subfoveal serous retinal detachment associated with a novel RP1L1 mutation (p.S1199P)

Purpose

The purpose of this study was to present an atypical case of occult macular dystrophy (OMD) with bilateral chronic subfoveal serous retinal detachment (SRD).

Methods

A 53-year-old man was ophthalmologically evaluated because of decreased visual acuity in both eyes. Genomic DNA was extracted from venous blood samples. Mutational analysis of the retinitis pigmentosa 1-like 1 (RP1L1) gene was performed by Sanger sequencing.

Results

Best-corrected visual acuity (BCVA) was 0.1 logMAR in both eyes until the age of 53, after which it gradually declined. Full-field electroretinography (ERG) was unremarkable, while multifocal ERG revealed a reduced central response in both eyes. Optical coherence tomography showed subfoveal SRD in both eyes, and fundus fluorescein angiography yielded unremarkable results. His brother and cousin had similar subjective symptoms. At age 58, his logMAR BCVA was 0.532 (OD) and 0.347 (OS). He was given 23 administrations of intravitreal bevacizumab (IVB; 1.25 mg) in both eyes alternately over a 2-year period and also underwent reduced-fluence photodynamic therapy in both eyes. Two years after the first administration of IVB, a reduction in SRD was obtained, and IVB was therefore discontinued. Three years after the first administration, logMAR BCVA was 0.155 (OD) and 0.523 (OS). Mutational analysis revealed a novel heterozygous missense mutation (p.S1199P).

Conclusions

We describe in detail a case of bilateral chronic subfoveal SRD in an atypical OMD patient carrying a novel heterozygous RP1L1 mutation (p.S1199P). Our results further extend the phenotypic spectrum of RP1L1-associated OMD.     

A 43-year-old man with reduced visual acuity and normal fundus: occult macular dystrophy—case report

Purpose Occult macular dystrophy (OMD) is an unusual, inherited macular dystrophy characterized by a slowly progressive decline of visual acuity with normal fundus and fluorescein angiography (FA). The authors present a 43-year-old man who was diagnosed as having OMD because of the results of electrophysiological, psychophysical, optical coherence tomography (OCT) tests. Methods Routine ophthalmological evaluation, FA, visual field tests, electroretinographic examinations (EOG, ERG, PERG and mfERG recordings according to ISCEV standards) and foveal thickness measurements (OCT) were performed. Results Funduscopic examinations, FA, full field ERG as well as PERG results were all normal. In both eyes, the abnormalities were observed in static perimetry (relative central scotomas), mfERG (significant reduction of P1 amplitude in the central retinas) and OCT (significantly thinner foveal thickness). Conclusions A new case with OMD is added to preceding reports. The mfERG and OCT tests are important in detection of OMD patients. It can help in differential diagnosis of amblyopia, optic nerve diseases and non-organic visual disorders.     

Multifocal electroretinography-assisted anatomical and functional evaluation of subthreshold green laser in acute central serous chorioretinopathy

Purpose:To compare observation versus subthreshold green laser (STL) in acute central serous chorioretinopathy (CSC) in terms of anatomical and functional outcomes.Methods:Prospective randomized interventional study. 30 eyes with the first episode of acute CSC underwent complete ophthalmologic examination, measurement of best-corrected Snellen visual acuity (BCVA), contrast sensitivity (CS), fundus fluorescein angiography (FFA), spectral-domain optical coherence tomography (SD-OCT), and multifocal electroretinography (mfERG) at baseline. Patients were randomized equally to group A (observation) or group B (STL using 532 nm wavelength applied to the leakage point). Outcome measures included BCVA, CS, central foveal thickness (CFT), and mean macular thickness (MMT) on SD-OCT and P1 amplitude and implicit time (IT) on mfERG. Patients were followed up for 6 months.Results:Mean BCVA was comparable between the two groups on follow up; however, mean CS was significantly higher in group B at 6 months (P = 0.032). CFT was significantly lower in group B at 1 month (P = 0.001) and 3 months (P = 0.049); however, this difference was not maintained at 6 months (P = 0.265). P1 amplitude and IT in all 5 rings were comparable between the two groups at baseline. On follow up, P1 amplitude of ring 1 became significantly higher in group B at 3 months (P = 0.036) and 6 months (P = 0.022).Conclusion:Immediate treatment of acute CSC with STL, as compared to conservative management, leads to more rapid resolution on SD-OCT and superior functional outcomes as evidenced by CS and mfERG.     

Ocular and Hemodynamic Factors Contributing to the Central Visual Function in Glaucoma Patients With Myopia

PurposeThe purpose of this study was to investigate the ocular and hemodynamic factors contributing to the central visual function in glaucoma patients with myopia.MethodsThis study was a prospective observational study, which included 236 eyes of 140 patients with normal-tension glaucoma (NTG), which includes 114 eyes with mild myopia (axial length ≥24 and <26 mm) and 122 eyes with moderate-to-severe myopia (axial length ≥26 mm). Ocular characteristics were axial length and posterior pole profiles, including peripapillary atrophy (PPA) to disc area ratio, disc tilt ratio, disc torsion, and disc-foveal angle. Hemodynamic factors included standard deviation of the mean of qualified normal-to-normal intervals (SDNN) of a heart rate variability (HRV) test and vessel density (VD) parameters from optical coherence tomography angiography (OCTA). The root mean square error was estimated as a measure of the VD fluctuation. Association between ocular characteristics and VD parameters of the OCTA with the central sensitivity of the 10-degree visual field or the presence of central scotoma were analyzed.ResultsDeep layer VD of the peripapillary and macular areas showed significant differences between mild and moderate-to-severe myopia (P = 0.034 and P = 0.045, respectively). Structural parameters, especially PPA to disc area ratio, had significant correlation with peripapillary VD parameters in myopic eyes. Lower SDNN value (ß = 0.924, P = 0.011), lower deep VD of the macular area (ß = 0.845, P = 0.001), and greater fluctuation of deep VD in the peripapillary area (ß = 1.517, P = 0.005) were associated with the presence of central scotoma in patients with glaucoma with myopia in multivariate logistic regression analysis.ConclusionsThe structural changes by myopia, especially in the peripapillary region, affected VD parameters in myopic eyes. Lower deep VD and greater VD fluctuation in the peripapillary region showed association with central scotoma in patients with glaucoma with myopia, suggesting both structural and vascular changes by myopia may be related to central visual function in glaucoma patients with myopia.     

Scotoma displacement in the macular mapping test as a tool for identification of preferred retinal loci

ObjectiveTo clarify the efficacy of the macular mapping test (MMT) to identify eccentric fixation with preferred retinal loci (PRL).DesignRetrospective observational case series from archived data.ParticipantsCases with age-related macular degeneration with low vision in both eyes and best corrected visual activity (BCVA) of 20/50 to 20/400 in the better eye.MethodsIdentification of preferred retinal loci with the Nidek MP-1 microperimeter and correlation with scotoma displacement on perimetry records as recorded with the MMT.ResultsWe recruited data on 43 patients (12 males and 31 females), aged 57–96 years (mean 84.05 years ± SD 8.00). Mean BCVA was 0.9 ± 0.32 SD logMar units (20/160). PRL location matched the direction of scotoma displacement in 32 study subjects (74.41%, p < 0.002).ConclusionsScotoma displacement recorded with the MMT offers reasonable indirect estimates on PRL location.     

Comparison of anatomical and functional outcomes of vitrectomy with internal limiting membrane peeling in recalcitrant diabetic macular edema with and without traction in Indian patients

Purpose:To study and compare the outcomes of pars plana vitrectomy (PPV) with the internal limiting membrane (ILM) peeling in the eyes with recalcitrant diabetic macular edema (DME) with and without vitreomacular traction.Methods:A comparative prospective interventional study was undertaken in which group 1 included 45 eyes of 45 patients with DME with vitreomacular tractional component and group 2 included 45 eyes of 45 patients with recalcitrant DME without a tractional component. Both groups underwent standard PPV with ILM peeling. All the patients were followed up for a minimum of 6 months. The parameters evaluated were changes in the best-corrected visual acuity (BCVA), central macular thickness (CMT), multifocal electroretinogram (mfERG) parameters, and occurrence of any intraoperative/postoperative surgical complication.Results:The mean CMT improved significantly from 540.6 and 490.2 μm at the baseline to 292.5 and 270.6 μm at 6 months in groups 1 and 2, respectively (P < 0.001). The mean BCVA logMAR improved from 0.78 ± 0.21 to 0.62 ± 0.22 in group 1 and 0.84 ± 0.19 to 0.65 ± 0.21 in group 2 at 6 months follow-up which was not statistically significant. The improvement in the mfERG was seen in group 2 as a significant increase in P1 wave amplitude in ring 2 (2–5°) (P < 0.004) and a significant decrease in P 1 wave implicit time in ring 1 (central 2°) (P < 0.001). None of the eyes suffered from the loss of BCVA or any major surgical complication in either group.Conclusion:PPV in recalcitrant DME provides good anatomical outcomes and the results are comparable in DME with and without a tractional component.     

Correlation between functional and anatomical assessments by multifocal electroretinography and optical coherence tomography in central serous chorioretinopathy

To evaluate the correlation between functional and anatomical assessments with multifocal electroretinography (mfERG) and optical coherence tomography (OCT) in patients with acute central serous chorioretinopathy (CSC). Thirty-four eyes of 34 patients with acute CSC underwent mfERG and OCT examinations. First-order mfERG N1 and P1 response amplitudes and latencies were analyzed. OCT parameters measured included central subretinal fluid (SRF) thickness, central retinal thickness, total central foveal thickness, vertical, and horizontal diameters of SRF, and macular volume. Correlation analyses were performed between best-corrected visual acuity (BCVA), mfERG parameters, and OCT measurements. Correlation analysis showed that logMAR BCVA was significantly correlated with mfERG N1 amplitudes of rings 1 and 2 (P = 0.006), N1 latency of ring 4 (P = 0.012), and P1 latency of ring 1 (P = 0.036). No significant correlation was observed between logMAR BCVA and any of the OCT measurements. For the correlation between mfERG parameters and OCT measurements, mfERG N1 and P1 latencies of the paracentral rings were significantly correlated with the central SRF thickness (P ≤ 0.024), diameters of the SRF (P ≤ 0.018), and macular volume (P ≤ 0.030). MfERG responses but not OCT measurements correlated with logMAR BCVA in patients with acute CSC. The amount of SRF nonetheless correlated with the mfERG N1 and P1 latencies of the paracentral rings, suggesting that impairment in the conduction of electrical responses in the paracentral macula is proportional to the severity of serous macular detachment in CSC. MfERG and OCT can complement each other in the functional and anatomical assessments in CSC.     

Visual loss and perimetric sensitivity in eyes with retinitis pigmentosa

Purpose

To investigate the various perimetric parameters that best predict reduction of best-corrected visual acuity (BCVA) to worse than 0.5 in the near future in eyes with retinitis pigmentosa (RP).

Methods

The most recent records obtained by Humphrey Field Analyzer (HFA) central 10-2 perimetry were studied for the right eyes of 123 patients (60 men and 63 women) with typical RP. The correlation between various parameters of perimetric sensitivity and BCVA was retrospectively studied. The receiver operating characteristic (ROC) curves were used to find the best parameter to discriminate eyes with BCVA ≥0.5 from those with BCVA <0.5.

Results

Spearman rank correlation coefficients with logMAR BCVA were the highest for the foveal threshold (FT) and mean sensitivity of the test points within 1.4° of the fixation point (MS1.4). The ROC curve analysis revealed that the area under the curve was the largest for the MS1.4 among all the perimetric parameters for discriminating eyes with BCVA ≥0.5 from those with BCVA <0.5. The cutoff value of 30 dB showed 100 % specificity and 57 % sensitivity.

Conclusions

The risk of vision decreasing below 0.5 in the near future may be predicted when the mean sensitivity within 1.4° of the fixation point in the HFA 10-2 reaches 30 dB in eyes with RP.     

Cirugía de las membranas epirretinianas: resultados anatómicos y funcionales

ObjectiveTo study the influence of anatomic preoperative characteristics (based on the parameter, foveal central thickness, measured by optical coherence tomography) and functional characteristics (based on the parameter, best corrected visual acuity, [BCVA]) on functional recovery after epiretinal membrane (ERM) surgery.MethodsA total of 88 eyes (of 86 patients), on whom a vitrectomy due to ERM was performed during a 3 years period were reviewed in this longitudinal, prospective study.An analysis was made of, ERM aetiology, BCVA, presence or absence of metamorphopsia, lens status, and central foveal thickness. Data relating to surgery and local complications, changes in BCVA, and changes in foveal central thickness were collected during the follow-up period.ResultsAn improvement was in observed in BCVA in 82%, as well as a decrease in foveal thickness in 79% of the eyes which underwent surgery, both of these being statistically significant (P<.01). However, most of the patients showed different grades of oedema and/or macular thickening in the postoperative period. A significant correlation was found between preoperative and postoperative BCVA (P=.001), and also between preoperative and postoperative central foveal thickness (P=.004), but not between BCVA and foveal thickness.ConclusionsThere is functional recovery in terms of BCVA in more than 80% of the patients after ERM surgery. Most of the eyes showed persistent macular thickening, but this did not seem to have influenced the final BCVA. The best determinant of postoperative functional recovery (postoperative visual acuity) is, in our experience, the preoperative BCVA, and not the macular thickness.     

Correlations among metamorphopsia test scores,optical coherence tomography findings and multifocal electroretinogram responses in epiretinal membrane patients

Purpose

To quantify metamorphopsia with a novel objective method in patients with epiretinal membrane (ERM) and to compare the relationships among metamorphopsia scores, spectral-domain optical coherence tomography (OCT) findings, and multifocal electroretinogram (mfERG) results.

Methods

This study included 52 eyes of 52 patients with idiopathic ERM who underwent comprehensive ophthalmologic examinations, including measurement of best-corrected visual acuity (BCVA), OCT, and mfERG. The degree of metamorphopsia was quantified using MonPack One® (Metrovision, Perenchies, France). On the topographic map of the early treatment diabetic retinopathy (ETDRS) grid, retinal thickness in the central, superior, inferior, nasal, and temporal subfields were measured, and metamorphopsia scores for each corresponding subfield were also obtained. The amplitudes and implicit times of mERG were elicited from each subfield. Then, the correlations among metamorphopsia scores, OCT findings, and mfERG responses were analyzed.

Results

The mean age of the patients was 65.3?±?18.5 y, and the average metamorphopsia score of the individual subfields was 2.03?±?1.18. Initial BCVA was 0.50?±?0.12 logMAR, but there was no significant correlation between metamorphopsia scores and BCVA. The metamorphopsia scores from the central subfields showed significant correlations with central retinal thickness (CRT) (p?=?0.001). The mean metamorphopsia scores in the central subfield showed a significant relationship with the mean N1 and P1 amplitudes (p?=?0.001, p?=?0.048, respectively), while no relationship was observed between metamorphopsia scores and mfERG amplitudes in other subfields.

Conclusions

The degree of metamorphopsia in patients with ERM could be objectively quantified in each subfield using a novel metamorphopsia test. The metamorphopsia scores were significantly correlated with retinal thickness, especially at the central subfields, and the scores in the central subfields were significantly correlated with the N1 and P1 amplitudes of mfERG. Thus, the metamorphopsia test can be a useful method to evaluate metamorphopsia symptoms for patients with ERM.

     

Multifocal electroretinogram findings after intravitreal bevacizumab injection in choroidal neovascularization of age-related macular degeneration

Purpose

To evaluate the changes in multifocal electroretinogram (mfERG) and optical coherence tomography (OCT) after intravitreal bevacizumab injection in the treatment of age-related macular degeneration (AMD).

Methods

Twenty-one eyes with choroidal neovascularization secondary to AMD were studied before and after intravitreal bevacizumab injection for best corrected visual acuity (BCVA), OCT, and mfERG.

Results

The BCVA improved, while central macular thickness and total macular volume in OCT decreased after intravitreal bevacizumab injection (p = 0.03, 0.01, and 0.01, respectively). In mfERG, the amplitude of P1, and implicit time of P1 and N1 indicated a statistically significant improvement of retinal response after intravitreal bevacizumab injection.

Conclusions

There is a potential role for mfERG in evaluating the effect on retinal function of intravitreal bevacizumab injection.     

Visual and anatomic outcomes of cataract surgery with intraoperative or postoperative complications in a teaching institution

ObjectiveTo review visual and anatomic outcomes after cataract surgery with complications in a teaching institution.MethodsConsecutive case series. A chart review was conducted of patients who underwent phacoemulsification with intraoperative or postoperative complications, performed by ophthalmology residents under direct supervision of experienced ophthalmology attending physicians. Best corrected visual acuity (BCVA), OCT parameters, and postoperative treatments were reviewed at 1, 3, 6, and 12 months postoperatively.ResultsOne hundred thirty-three eyes were analyzed. Mean BCVA was 50 ± 23 approximate Early Treatment Diabetic Retinopathy Study letters at the preoperative visit and improved by a mean of 8 letters (n = 128; p = 0.001), 16 letters (n = 117; p < 0.001), 14 letters (n = 79; p < 0.001), and 4 letters (n = 34; p = 0.37) at 1, 3, 6, and 12 months. The mean OCT central subfoveal thickness increased by less than 50 μm at all time points and this change was not statistically significant at 12 months. BCVA increased by 3 lines in 41%, 56%, 57%, and 44% of eyes at 1, 3, 6, and 12 months. Median BCVA was 20/40 or better at each follow-up period. Fifty-three (40%) eyes required a secondary surgical procedure due to intraoperative or postoperative complication. A significant proportion of eyes received anti-inflammatory drops through 1 year.ConclusionsAfter cataract surgery with intraoperative or postoperative complications, a majority of eyes experienced substantial visual gains and only mild retinal thickening while being managed with long-term anti-inflammatory drops and additional surgical procedures.     

Focal functional and microstructural changes of photoreceptors in eyes with acute zonal occult outer retinopathy

Purpose

Acute zonal occult outer retinopathy (AZOOR) is characterized by an acute zonal loss of outer retinal function with minimal ophthalmoscopic changes in one or both eyes. We present a patient with AZOOR whose ultrastructural and functional findings were followed for 8 months.

Case

A 22-year-old woman developed an acute central scotoma in her right eye. Her best-corrected visual acuity (BCVA) was 0.5 OD and 1.2 OS. The ophthalmoscopic examinations, fluorescein angiography, and full-field electroretinograms (ERGs) were normal in both eyes. The amplitudes of the multifocal ERGs (mfERGs) were attenuated in the area corresponding to the scotoma. Spectral domain optical coherence tomography showed an absence of both the inner and outer segment (IS/OS) line of the photoreceptors and the cone outer segment tip (COST) line between the IS/OS line and the retinal pigment epithelium. These changes were seen in the area corresponding to the scotoma. One month later, the scotoma disappeared and the BCVA improved to 1.2 OD. The mfERGs increased to almost the same amplitude as the fellow eye. The IS/OS line became discernible but the COST line was still absent. The ophthalmological findings of the right macula remained normal during the 11-month follow-up period.

Conclusions

Our findings indicate that the selective loss of the IS/OS and the COST lines is probably the morphological alterations corresponding with the reduced BCVA and the mfERGs in the areas of the visual field defects in the acute phase of AZOOR. But in the recovery phase, only the abnormality of the COST line is a subclinical sign for the disease. These findings should be important in understanding and evaluating the pathological mechanism in other outer retinal diseases.Key Words: Acute zonal occult outer retinopathy, Perimetry, Multifocal electroretinogram, Optical coherence tomography, External limiting membrane, Photoreceptor inner and outer segment line, IS/OS line, Cone outer segment tips     

Functional evaluation of the macular area in early glaucoma using microperimetry

Purpose:To evaluate the central visual field by microperimetry (MP), in early glaucoma.Methods:Consecutive perimetrically experienced patients with a single nasal step or arcuate scotoma and 14 control eyes underwent MP. Retinal sensitivity on MP was mapped for frequency and depth of loss in the central 10° around fixation.Results:Twenty-one eyes had a single nasal step and 19 eyes with single arcuate scotoma on standard automated perimetry (SAP), with central 10° being normal on 30–2 and 10–2 perimetry. The average mean sensitivity on MP, in glaucomatous and control eyes was 11.8 ± 3.9 dB and 16.6 ± 1.2 dB, respectively, P = 0.0004. The average mean defect on MP-1, in glaucomatous and control eyes was - 6.5 ± 2.0 dB and - 3.0 ± 1.2 Db, respectively, P = 0.05. The corresponding retinal hemisphere showed significant defects in MP. In eyes with single nasal steps, an absolute scotoma was seen in 14–28% of eyes 8–10° off fixation, moderate to mild defects were seen in 10–52% eyes, and 10% eyes showed involvement up to 4° from the fixation. Eyes with arcuate scotoma had an absolute scotoma on MP in 95% of eyes, 6–10° from fixation, with extension up to 2° from fixation in 21%. In glaucomatous eyes, the normal hemisphere on SAP showed a mild defect on MP in 43%. Control eyes did not show any defect in SAP or MP.Conclusion:A significant loss of central retinal sensitivity is recorded on MP in early glaucomatous neuropathy as compared to SAP. Paramacular absolute defects were seen at 6–10° from fixation.     

Diagnosis of retinal diseases. Comparison between multifocal ERG and fundus perimetry - a case study

Background. There are new methods available for function testing of the macula, i.e. multifocal Electroretinography (mfERG) as well as fundus perimetry with the scanning laser ophthalmoscope (SLO). The value and clinical impact of these methods have still to be evaluated. We wanted to compare the results from patients having undergone both examinations. Patients and methods. A total of 33 eyes from 25 patients (visual acuity 0.03–0.8) aged 14–79 years were examined using fundus perimetry with the SLO. In addition, multifocal ERG was performed in all eyes, where 61 local ERGs inside the 30° visual field were recorded. We compared the depth of the scotoma with the reduction of the amplitudes during mfERG taking the fixation status into consideration. Results. Examination time was comparable for both examination techniques. There was good concordance for eyes with retinitis pigmentosa with only central response. In contrast, patients with juvenile macular dystrophy demonstrated different results with comparable size of the defect while sometimes an enlarged pathology during mfERG was observed. Correlation between pathology findings observed in mfERG and fundus changes was difficult due to the change of the point of fixation caused by central scotoma. In age-related macular degeneration correlation of the findings was less obvious. Discussion. The different setting with supra-threshold stimuli during ERG in contrast to near-threshold stimulus presentation during perimetry, might be the reason for differences even in the beginning of retinal diseases. In addition, reduced stability of fixation leads to artifacts during mfERG while it may be compensated for in fundus perimetry. Both methods are of additional value and demonstrate different results depending on the disease.     

Microperimetry and mfERG as functional measurements in diabetic macular oedema undergoing intravitreal ranibizumab treatment

PurposeTo evaluate Microperimetry (MP) and multifocal electroretinogram (mfERG) as whole-macula functional markers of treatment response in naive diabetic macular oedema (DMO) patients undergoing ranibizumab treatment.MethodsAn exploratory sub-analysis of a prospective study ({"type":"clinical-trial","attrs":{"text":"NCT01947881","term_id":"NCT01947881"}}NCT01947881-CHARTRES). Patients received three monthly ranibizumab injections (loading dose) followed by pro re nata (PRN) regimen during 1 year. At baseline, during and after treatment (Months 0, 3, 6 and 12), subjects were tested using BCVA, OCT, MP and mfERG. MP was performed in the central 12°, and retinal sensitivity was measured overall (mean sensitivity (MS)), and in three concentric rings (R1–R3). mfERG P1 amplitude and implicit time were measured over six concentric rings (R1–R6).ResultsThirty-two eyes were included. MP mean and rings sensitivity were significantly lower in DMO (p < 0.001). After loading dose, a significant improvement in retina sensitivity was observed, particularly in good BCVA responders (MS = +2.28 dB; R1 = +2.33 dB, R2 = +2.20 dB, R3 = +2.25 dB; p = 0.049). Overall retinal sensitivity was significantly correlated with BCVA improvement (r = 0.54; p = 0.026) and inversely correlated with OCT central subfield thickness improvement (r = −0.39; p = 0.026). mfERG amplitude and implicit time were also lower in DMO (p < 0.011). An improvement of mfERG P1 amplitude and implicit time in R1 was noted in good responders after ranibizumab loading dose (+16.49 nV/deg²; p = 0.013 and −0.005 ms; p = 0.048, respectively). When changing to PRN treatment regimen, BCVA was maintained during the 12 months of follow-up but worsening of the visual function was detected by MP and mfERG.ConclusionsMicroperimetry and mfERG were able to demonstrate DMO functional improvement after treatment loading dose, as well as early visual changes when treatment regimen was switched to PRN.Subject terms: Predictive markers, Retinal diseases     

Outer retinal morphological changes and visual function after removal of epiretinal membrane

ObjectiveTo determine the relation between the recovery of the cone outer segment tips (COST) line and the best-corrected visual acuity (BCVA) after epiretinal membrane (ERM) surgery.DesignRetrospective, consecutive, interventional case series.ParticipantsSixty-one eyes of 56 patients with an idiopathic ERM were studied. All participants underwent a complete ophthalmic examination including spectral-domain optical coherence tomography before and after ERM removal surgery.MethodsThe integrities of the photoreceptor layer including the external limiting membrane line, photoreceptor inner segment/outer segment (IS/OS) line, and COST line in the spectral-domain optical coherence tomography images at the fovea were determined. The associations of these morphological parameters to the BCVA were determined.ResultsBetter BCVAs were found more frequently in eyes with an intact COST line than in eyes with a disrupted or absent COST line at 1 (p < 0.001), 6 (p = 0.003), and 12 months (p < 0.001). Among the external limiting membrane, IS/OS, and COST line parameters, the IS/OS line had higher correlations with the BCVA by multivariate analysis. No significant difference was observed in central retinal thickness between eyes with intact and nonintact COST lines. Eight (30.8%) of 26 eyes with BCVA ≥ 20/20 had nonintact COST lines at 12 months after the ERM surgery.ConclusionsEyes with an intact COST line had better BCVA after ERM surgery. However, even at 12 months after ERM surgery, COST lines remained disrupted in many eyes with good BCVA.     

Prospective evaluation of aflibercept in pigment epithelial detachments secondary to neovascular age related macular degeneration

ObjectiveTo assess the efficacy of intravitreal aflibercept in treating visual loss and structural changes in patients with pigment epithelial detachments (PED) secondary to neovascular age-related macular degeneration (nAMD).MethodsProspective, exploratory, open-label study (ClinicalTrials.gov Identifier: NCT02142296). Participants with PED secondary to nAMD were enrolled and received intravitreal aflibercept injection on a monthly basis for 3 months, followed by injections on a bimonthly basis for another 9 months. Best-corrected visual acuity (BCVA), ophthalmic examinations, optical coherence tomography (OCT) imaging, and fluorescein angiography were performed based on a predetermined schedule.ResultsThirty-six participants (37 eyes) were enrolled. At the end of study, 74.3% eyes demonstrated PED height reduction of 25% or more and 34.3% demonstrated complete resolution. The average reduction in retinal thickness was 128.4 μm. Participant eyes who had at least a 25% reduction in PED height at month 4 were labelled as “responders” (73.0%, n = 27), and those who had less than 25% reduction in PED height were labelled as “partial-responders” (27.0%, n = 10). Responders demonstrated more significant reduction in PED height than partial-responders (p <0.0001). The average gain in BCVA was 10.1 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. Responders demonstrated more gain in BCVA than partial-responders (p = 0.0018). Among the responders, 57.7% demonstrated disease recurrences with increase in PED height during bimonthly dosing.ConclusionsIntravitreal aflibercept injection for patients with PEDs secondary to nAMD has high response rate with few adverse events. Responders demonstrated BCVA gains, as well as structural improvements. However, high recurrence rate was found on bimonthly maintenance dosing.     

Functional and anatomic changes between early postoperative recovery and long-term follow-up after combined epiretinal and internal limiting membrane peeling

ObjectiveTo evaluate short- and long-term changes in best-corrected visual acuity (BCVA) and retinal layer thicknesses after combined epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling for macular holes and symptomatic ERMs.DesignRetrospective observational case series.ParticipantsPatients with ERMs or with macular holes and ERMs treated with combined ERM and ILM peeling.MethodsStudy eyes (n = 36) and healthy fellow eyes (n = 17) were evaluated using the automated segmentation of retinal layers performed by SPECTRALIS software that automatically calculated the average central retinal thickness and the average thickness in each of the individual retinal layers. The analysis was performed at 6–18 months after surgery and after 60 months.Main Outcome MeasuresChanges in BCVA and retinal layer thicknesses determined by automated segmentation at the first and last follow-up visits.ResultsBCVA improved from a baseline 0.48 ± 0.25 logMAR (20/60 Snellen) to 0.18 ± 0.18 logMAR (20/30 Snellen) at the short-term postoperative examination (p < 0.0001). Between first and last follow-up visit, 5 eyes (14%) were classified as better, 28 (78%) as stable, and 3 (8%) as worse. BCVA of the control fellow eyes remained stable during the follow-up. The thicknesses of retinal layers decreased significantly (p < 0.009). At the last follow-up, the ganglion cell layer was thinner and the inner nuclear layer was thicker in the operated eyes compared with the healthy fellow eyes.ConclusionCombined ERM and ILM peeling may improve BCVA in some patients. However, over a long follow-up period, it can be associated with progressive ganglion cell layer thinning that could affect BCVA stability.     

Fixation pattern and macular sensitivity in eyes with subfoveal choroidal neovascularization secondary to age-related macular degeneration. A microperimetry study

Purpose. To investigate the effects of subfoveal choroidal neovascularizzation (CNV) secondary to age-related macular degeneration (AMD) on macular functional parameters quantified with an automatic fundus perimeter. Methods. 118 eyes of 98 consecutive patients with subfoveal CNV secondary to AMD were evaluated. Best corrected visual acuity (ETDRS charts), fundus photography, and fluorescein angiography were performed. Microperimetry (fundus-related perimetry) was used to quantify macular sensitivity and fixation pattern (location and stability). Results. Of 118 eyes: 26 (21.9%) had central, 18 (15.1%) poor central and 74 (63.0%) eccentric fixation; 31 (26.0%) had stable, 42 (35.6%) relatively unstable and 45 (38.4%) unstable fixation. In 75 eyes (63.4%) a dense central scotoma was found. Angiographic classification of subfoveal CNV (occult versus classic) was not significantly related to fixation pattern (location: P = 0.274; stability: P = 0.385), and presence of dense scotoma (P = 0.41). Conclusion. Microperimetric quantification of macular sensitivity and fixation pattern in eyes with subfoveal CNV secondary to AMD offers new data about the impact of visual impairment in these eyes. Moreover, microperimetry improves the functional evaluation of subfoveal CNV in AMD.