Evaluation of Macular Function with Microperimetry and Multifocal Electroretinogram in Macular Hole Surgery

We aim to review scientific literature concerning published studies on autologous retinal transplantation to treat macular hole patients. The following databases were searched: Medline and Medline Non-Indexed Items, Embase (1990–2020), Ovid Medline® (1990 to November 2020), Embase (1990 to November 2020), Ovid Medline® and Epub Ahead of Print, in-Process and Web of Science (all years). Search keywords included “autologous”, “retinal transplant”, “autologous neurosensory retinal free flap” “transplantation”, “macular hole”, and “macular hole surgery”. Eighteen case series and single case reports were reviewed. Preoperative and final best-corrected visual acuity, microperimetry and multifocal electroretinogram findings, macular hole closure rate, preoperative and postoperative ellipsoid zone, and external limiting membrane defects were obtained and analyzed. Indications of autologous retinal transplantation for macular hole surgery included refractory macular holes, conventional techniques, and large macular holes. The number of cases included in the different case series ranged from 2 to 130 cases, and prior macular hole surgeries of the patients ranged from 0 to 3. Overall, the published case series of autologous retinal transplants have reported a macular hole closure rate of 66.7 to 100%, as well as a significant improvement in best-corrected visual acuity. The most frequently reported complications included considerable intraoperative bleeding and postoperative dislocation of the graft. The presence of functionality in the graft area has also been documented by microperimetry and multifocal electroretinogram. In conclusion, the autologous retinal transplantation technique for macular hole patients has emerged as another surgical option, with a high macular hole closure rate and visual improvement.

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Multifocal Electroretinography in Assessment of Macular Function after Internal Limiting Membrane Peeling in Macular Hole Surgery

Journal of Ophthalmology ◽

10.1155/2019/1939523 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

M. Y. Faria ◽

D. C. Sousa ◽

S. Mano ◽

R. Marques ◽

N. P. Ferreira ◽

...

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Functional Results ◽

Internal Limiting Membrane ◽

Multifocal Electroretinography ◽

Ilm Peeling ◽

Macular Hole Surgery ◽

Macular Function ◽

Retinal Layers ◽

Snellen Visual Acuity

Purpose. Internal limiting membrane (ILM) peeling is important for macular hole (MH) surgery but may have secondary effects visible on spectral domain optical coherence tomography (OCT) and multifocal electroretinography (mfERG). We relate integrity of inner and outer macular layers with functional results with mfERG. Methods. Nonrandomized prospective study of 33 consecutive eyes of 33 patients with macular hole who underwent vitrectomy with ILM peeling. Best-corrected visual acuity was assessed, and integrity of external layers was measured using OCT. Each component of mfERG, N1 and P1 amplitude and latency, was also measured. Results. All eyes showed macular hole closure. Visual acuity improved from 20/400 to 20/40 in the Snellen visual acuity chart (P<0.001), and OCT external lines were intact in 19 eyes and disrupted in 14 eyes. Postoperatively, N1 and P1 amplitudes in ring 1 increased compared to preoperative values (P<0.001 for both). Latency remained delayed for both N1 and P1 wave. In the group of 19 eyes with integrity of outer retinal layers, N1 amplitude in ring 1 was superior to the group of 14 patients with disrupted outer retinal layers (P=0.042). Conclusions. In macular hole surgery, structure analysis in OCT is one of the important outcomes for the retinal surgeon. Functional results are parallel with anatomic results, but visual gain is limited. The limited recovery in mfERG suggests an alteration of retinal physiology that could explain limited vision recover.

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Macular function assessment by multifocal electroretinogram and microperimetry in macular hole and correlation with visual acuity

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v12i1.25759 ◽

2020 ◽

Vol 12 (1) ◽

pp. 7-16

Author(s):

Daleena Dalan ◽

Durgasri Jaishankar ◽

Abinaya Madhu ◽

Karthiga Mani ◽

Dhanashree Ratra

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Recovery Of Function ◽

Multifocal Electroretinogram ◽

Visual Outcome ◽

Internal Limiting Membrane ◽

Retinal Sensitivity ◽

Regression Equations ◽

Macular Function ◽

The Mean

Background: Functional outcome of macular hole (MH) surgery can be better assessed with multifocal electroretinogram (mfERG) and microperimetry (MP). It might provide better assessment than the Snellen visual acuity alone. Objectives: To evaluate macular function with mfERG and microperimetry, and assess their correlation with visual acuity in MH. Materials and Methods: A prospective study was done in patients with unilateral,idiopathic full thickness MH. Standard surgery with vitrectomy, internal limiting membrane peeling and gas tamponade was done. Snellen and logMAR visual acuity, mfERG, microperimetry and optical coherence tomography were done pre and postoperatively. Results: Twenty six patients with unilateral macular hole and twenty five age matched controls were included. The mean age of patients was 59.92±9.39 years (range: 40 to 74 years). All the holes were closed after surgery (two required second surgery). The mean visual acuity improved from 0.77±0.34 logMAR to 0.43±0.36 (p =0.03). The mfERG amplitudes differed ring wise, but the average amplitude changed from 26.31±8.82 to 20.52±7.11 (p =0.03). The mean retinal sensitivity changed from 12.98±2.59 to 13.42±2.53 (p =0.11). There was significant correlation between visual acuity and mfERG amplitudes and retinal sensitivity. Regression equations to predict visual outcome could be derived. Conclusions: In MH, mfERG and microperimetry show reduced responses, delay in recovery of function. They show a strong correlation with visual acuity. It is possible to predict vision after surgery with the help of mfERG and MP. Improved ability to predict visual outcome can increase the utility of anatomic success predictors.

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Faculty Opinions recommendation of The Effect of Postoperative Face-Down Positioning and of Long- versus Short-Acting Gas in Macular Hole Surgery: Results of a Registry-Based Study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726177958.793520404 ◽

2016 ◽

Author(s):

Carl Regillo ◽

Sundeep Kasi

Keyword(s):

Macular Hole ◽

Macular Hole Surgery ◽

Short Acting

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Electrophysiological Monitoring of Focal and Entire Retinal Function during Treatment with Intravitreal Methotrexate for Intraocular Lymphoma

Case Reports in Ophthalmology ◽

10.1159/000514189 ◽

2021 ◽

pp. 277-282

Author(s):

Takashi Matsushima ◽

Yuji Yoshikawa ◽

Airi Shimura ◽

Ayana Yajima ◽

Yui Ojima ◽

...

Keyword(s):

Multifocal Electroretinogram ◽

Malignant Lesion ◽

Central Area ◽

Interleukin 10 ◽

High Ratio ◽

Retinal Function ◽

Intraocular Lymphoma ◽

Blurred Vision ◽

Macular Function ◽

Skin Electrodes

We describe the electroretinographic findings of a case of primary intraocular lymphoma (PIOL) wherein the patient received intravitreal injections of methotrexate (ivMTX). A 62-year-old man developed blurred vision and complained of decreased visual acuity (VA) in his right eye. Fundus examination showed vitreous opacity and multiple subretinal yellowish lesions. Optical coherence tomography (OCT) revealed subretinal and intraretinal infiltrations. The full-field electroretinogram (ffERG) showed subnormal combined rod-cone response and multifocal electroretinogram (mfERG) recorded using skin electrodes showed severe attenuation of the response compared with the other eye. Pars prana vitrectomy, phacoemulsification, and lens implantation were performed to remove the opacity, and vitreous biopsy revealed a high ratio of interleukin 10–6 (76.0). There was no systemic malignant lesion, and the patient was diagnosed with PIOL. Treatment with ivMTX (400 μg/0.1 mL) was started. One month later, the intraretinal infiltration had disappeared, and mfERG revealed recovery of the response density from the central area. Two months later, OCT showed recovery of the foveal ellipsoid and interdigitation zones, and VA recovered to 20/17; mfERG showed maintenance of macular function. However, the amplitude of a- and b-waves in the ffERG gradually decreased. Macular function recovered, but there was also a decrease in total retinal function. mfERG and ffERG recorded using skin electrodes were useful in monitoring macular and entire retinal function with repeated examinations and showed recovery and maintenance of macular function in a case of PIOL treated with ivMTX.

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