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Purpose: To determine the association of the multifocal electroretinographic (mfERG) response amplitude with the volumes of the inner, postreceptor, and photoreceptor retinal layers in the region stimulated by each mfERG element. Methods: Sixteen healthy, young adult control subjects were studied. Each of the 103 hexagonal elements of the standard, scaled mfERG were aligned, where possible, with patches of retina imaged using optical coherence tomography. Stimuli falling on the fovea and on the optic nerve head were excluded. Linear mixed-effects modeling was then used to derive estimated coefficients (voltage/volume) for the mfERG response throughout the full 80 ms standard epoch. The resulting predicted response amplitudes originating in each layer were then compared to pharmacologically "dissected" mfERGs obtained from other studies in monkey eyes. Results: Across the duration of the response, the amplitude of the modeled contribution from (1) the inner retina was small-to-modest, (2) the postreceptor retina was larger and contained two prominent peaks, and (3) the photoreceptor response was the largest and most closely paralleled the overall (i.e., intact) response, including late-appearing oscillations. The significance of each layer's contribution was greatest when the absolute amplitude of that layer's response was largest. The contribution of the inner retina was maximally significant in the interval between the prominent troughs and peaks of the intact response. The contributions of the postreceptor and photoreceptor responses were maximally significant at the prominent troughs and peaks of the intact response. Conclusions: The results of the model were in good overall agreement with previous interpretations of the cellular contributions to the mfERG. There was also fair agreement with pharmacologically dissected monkey mfERG responses. Thus, the estimations of the contributions of the retinal layers to the mfERG so produced appeared plausible.

Introduction Multifocal simultaneous imaging challenges the visual system to process the multiple overlaps of focused and defocused images. Retinal image processing may be an important step in neuroadaptation to multifocal optical images. Our aims are, firstly to evaluate the short-term effect of different multifocal contact lenses (MF) on retinal activity in young healthy subjects (Experiment#1) and secondly, to evaluate any changes in retinal activity in presbyopic patients fitted with MF over a 15-day period (Experiment#2). Methods In Experiment-#1, 10 emmetropic healthy young subjects were included to evaluate the short-term effect of different MFs designs. In Experiment #2, 4 presbyopic subjects were included to wear MF for 15 days. Following the ISCEV Standards, multifocal electroretinograms (mfERGs) were recorded to evaluate different retinal regions under different conditions: with single vision contact lens (SVCL) and with center-distance and center-near MF. Results In Exp#1 the peak time of N1, P1 and N2 were found to be delayed with the MF (p, This study was founded by Portuguese Foundation for Science and Technology (FCT, PTDC/FIS-OPT/0677/2014); FCT Strategic Funding (UID/FIS/04650/2013) and FCT-SFRH/BPD/92365/2013 (to Paulo Fernandes) and FCT-SFRH/BD/136684/2018 (to Ana Amorim-de Sousa).

Purpose Multifocal electroretinogram (mfERG) shows great utility as a screening tool to detect early hydroxychloroquine (HCQ) retinopathy, but its widespread use is limited by the lack of accessibility and long test duration. In this study, we evaluated a novel concentric 5-ring mfERG stimulus to provide a simplified and rapid protocol for screening HCQ toxicity. Methods Patients referred for HCQ retinopathy screening were consented to this observational cross-sectional study. Patients with amblyopia, high refractive error (more than 8 diopters), other retinal diseases precluding appropriate evaluation or history of retinal surgery were excluded. The data were collected from patients undergoing HCQ screening at a single center from July 2019 to March 2020. Patients were tested with the new concentric 5-ring mfERG stimulus, standard 61-hexagon mfERG stimulus, spectral domain optical coherence tomography and automated 10-2 visual fields. For the main outcome, the 5-ring mfERG was compared to 61-hexagon stimulus to determine the time-to-test completion and assess the association between ring (R1–R5) amplitude and ring ratio compared against cumulative dose, dose by real body weight and duration of therapy using Pearson correlation. Results In total, 52 patients (104 eyes; 5 males and 47 females) were recruited with a mean age of 59 years (range 23–85 years). The 5-ring protocol was markedly quicker to perform (1.3 ± 0.2 min; mean (SD)) compared to the 61-hexagon protocol (5.2 ± 0.6 min), p n = 10 patients. The new R2/R5 ring ratio showed a moderate correlation with daily dose (r = − 0.640), cumulative dose (r = − 0.581) and duration of therapy (r = − 0.417). Similar correlations were observed with the new R2/R4 ring ratio which were not significantly different from the new R2/R5 correlation coefficients. The new R2/R5 ring ratio demonstrated a stronger correlation with daily (p = 0.002) and cumulative dose (p = 0.0001) compared to the 61-hexagon stimulus. Conclusions In this exploratory study, our novel 5-ring mfERG protocol significantly shortened data acquisition time while providing comparable results to the standard 61-hexagon stimulus for detecting HCQ-induced electrophysiological changes that are correlated with HCQ dosages and treatment duration. Our protocol has the potential to be more clinically practical by simplifying routine screening.

(1) Background: Diabetic retinopathy (DR) is a diabetes mellitus (DM) complication where neurodegeneration plays a significant role. The aim of our study was to determine the differences between type 1 DM (T1DM) and 2 DM (T2DM) in the multifocal electroretinogram (mERG).; (2) Methods: A mERG study was performed in two groups, a T1DM group with 72 eyes of 36 patients compared with 72 eyes of 36 patients with T2DM, randomly selected from our DM databases, without DR. We studied how HbA1c and DM duration affects amplitude and implicit time of mERG; (3) Results: the study of DM duration shows patients with T1DM have lower amplitude values compared to T2DM patients, although implicit time increases in patients with T2DM. HbA1c over 7% only affects T1DM patients with an increase of implicit time; (4) Conclusions: the retinas of patients with T1DM seem more sensitive to changes in HbA1c levels than in patients with DMT2, although the duration of diabetes affects both types of DM 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.

Introduction Our aim was to evaluate the effects of 36 months of treatment with citicoline and vitamin B12 eye drops on macular function in patients with type 1 diabetes (DM1) with mild signs of non-proliferative diabetic retinopathy (NPDR). Methods A prospective, randomized, interventional, monocentric, double-masked study was conducted. Twenty patients with DM1 were enrolled and randomly divided into two groups: the DC group (10 patients; mean age ± standard deviation 46.86 ± 8.78 years) in which one eye of each patient was treated with citicoline and vitamin B12 eye drops (OMK2®, Omikron Italia srl, Italy, one drop thrice daily) for a period of 36 months; the DP group (10 patients; mean age ± standard deviation 47.89 ± 7.74 years) in which one eye of each patient was treated with placebo (eye drops containing hypromellose 0.3%, one drop thrice daily) for a period of 36 months. A total of 18 eyes (10 from the DP and 8 from the DC group, respectively) completed the study. In both groups, multifocal electroretinogram (mfERG) recordings were assessed at baseline and after 36 months. In mfERG analysis, the N1–P1 response amplitude density (RAD) evaluated in the 0–2.5° (ring 1), in the 2.5–5° (ring 2), in the 5–10° (ring 3), and in the 0–10° (ring 1 + ring 2 + ring 3) were considered. Results With respect to baseline, after 36 months of follow-up, the mfERG RADs recorded in R1, R2, R3, and R1 + R2 + R3 were significantly increased (i.e., R1 + R2 + R3 RAD from 21.552 ± 2.522 nV/degree2 at baseline to 26.912 ± 2.850 nV/degree2 at 36 months) in DC eyes, whereas in DP eyes they were significantly reduced (i.e., R1 + R2 + R3 RAD from 21.033 ± 3.574 nV/degree2 at baseline to 16.151 ± 3.571 nV/degree2 at 36 months). Conclusions This study indicates that patients with NPDR treated with citicoline and vitamin B12 eye drops for a 36-month period achieved an improvement of the macular bioelectrical responses detectable by mfERG recordings. By contrast, during the same period of follow-up, patients with NPDR treated with placebo showed a worsening of the macular function.

Purpose To propose a new method of identifying clusters in multifocal electrophysiology (multifocal electroretinogram: mfERG; multifocal visual-evoked potential: mfVEP) that conserve the maximum capacity to discriminate between patients and control subjects. Methods The theoretical framework proposed creates arbitrary N-size clusters of sectors. The capacity to discriminate between patients and control subjects is assessed by analysing the area under the receiver operator characteristic curve (AUC). As proof of concept, the method is validated using mfERG recordings taken from both eyes of control subjects (n = 6) and from patients with multiple sclerosis (n = 15). Results Considering the amplitude of wave P1 as the analysis parameter, the maximum value of AUC = 0.7042 is obtained with N = 9 sectors. Taking into account the AUC of the amplitudes and latencies of waves N1 and P1, the maximum value of the AUC = 0.6917 with N = 8 clustered sectors. The greatest discriminant capacity is obtained by analysing the latency of wave P1: AUC = 0.8854 with a cluster of N = 12 sectors. Conclusion This paper demonstrates the effectiveness of a method able to determine the arbitrary clustering of multifocal responses that possesses the greatest capacity to discriminate between control subjects and patients when applied to the visual field of mfERG or mfVEP recordings. The method may prove helpful in diagnosing any disease that is identifiable in patients’ mfERG or mfVEP recordings and is extensible to other clinical tests, such as optical coherence tomography., Agencia Estatal de Investigación

Background: Currently there is no medical treatment for X-linked retinoschisis (XLRS). In many retinal dystrophies, carbonic anhydrase inhibitors (CAIs) are effectively used to reduce cystoid macular edema. Prospective studies investigating the effect of CAIs in patients with XLRS are needed for the evaluation of their efficacy in this disease. The purpose of our work is to investigate the effects on macular morphology and function of oral CAIs used for the treatment of foveal lesions in patients with XLRS. Methods: Nineteen patients with a clinical diagnosis of XLRS were enrolled and prescribed oral CAIs for six months. We evaluated the therapeutic effect of CAIs with: best-corrected visual acuity (BCVA), spectral-domain optical coherence tomography, microperimetry (MP) and multifocal electroretinography (mfERG). Results: We observed a significant improvement of BCVA (p-value = 0.013), central retinal thickness (p-value = 0.004) and macular sensitivity (p-value

Introduction This study aimed to evaluate whether treatment with fingolimod (FTY) may induce functional changes on the macular pre-ganglionic retinal elements in patients affected by relapsing–remitting multiple sclerosis (RR-MS) without optic neuritis (ON). Methods This case–control observational and retrospective study assessed multifocal electroretinogram (mfERG) responses from 35 healthy controls (mean age 43.58 ± 5.76 years), 41 patients with RR-MS without ON (mean age 40.64 ± 4.83 years, MS-noFTY group), and from 21 patients with RR-MS without ON (mean age 42.38 ± 12.34 years) and treated with fingolimod (Gilenya®, Novartis Europharm, 0.5 mg/day) (MS-FTY group). MfERG N1 and P1 implicit times (ITs), and N1–P1 response amplitude densities (RADs) were measured from concentric rings (R) with increasing foveal eccentricity: 0–5° (R1), 5–10° (R2), 10–15° (R3), 15–20° (R4), 20–25° (R5). We considered R1 and R2 as “central macular areas” and R3, R4 and R5 as “more eccentric retinal areas”. In the MS-FTY group, mfERG recordings were performed between 6 and 12 months (mean 7.2 ± 1.5 months) from the start of FTY. Results In the MS-FTY group, the mean values of mfERG N1 and P1 ITs and RADs detected in both central macular areas (R1 and R2) and in more eccentric retinal areas (R3, R4 and R5) were not significantly different (p > 0.01) with respect to those of control and MS-noFTY groups. Conclusions Our mfERG results suggest that the chronic use of FTY does not induce a dysfunction of pre-ganglionic retinal elements located in the 0–25° of central retina. Since FTY does not cause any retinal functional abnormality, we suggest that FTY treatment could not produce any toxic effect on pre-ganglionic retinal elements even in the absence of macular oedema.

Purpose: To report an early stage of gyrate atrophy (GA) of the retina and choroid for which spectral-domain optical coherence tomography (SD-OCT) images revealed an obscured interdigitation zone (IZ). Observation: A 13-year-old boy was referred to our department due to blurred vision in his left eye. Best corrected visual acuity was 20/20 and 20/25 in the right and left eye, respectively. Fundus examination revealed scalloped atrophic peripheral chorioretinal lesions in both eyes. Concentrations of plasma and urine ornithine were 1192 nmol/mL and 1930 μmol/g·cre, respectively. Consequently, he was diagnosed with GA. Although Goldmann perimetry found no abnormalities, electroretinogram (ERG) revealed loss of the rod responses and significant attenuation of the cone responses in both eyes. Detailed analysis of the posterior part of the fundus using multifocal electroretinogram showed poor responses, specifically in the nasal macular area of the left eye. SD-OCT showed an obscured IZ corresponding to the attenuated cone response determined by ERG. There was preservation of the retinal pigment epithelium, ellipsoid zone and external limiting membrane. Conclusions and Importance: Obscured IZ during early stage GA was confirmed in a teenage patient with a chief complaint of blurred vision. OCT is useful in the detection of minute morphological changes that occur earlier in GA.

AIM: To analyze the clinical efficacy of intravitreal injection of ranibizumab (IVR) on diabetic macular edema (DME) with multifocal electroretinography (mfERG) and optical coherence tomography (OCT). METHODS: A total of 41 patients (41 eyes) with DME were treated with IVR. The best corrected visual acuity (BCVA), mfERG results, and OCT were analyzed to compare to the baselines at 1wk, 1, and 3mo after operation. RESULTS: The BCVA was significantly improved in all eyes at each time point (P

Spinocerebellar ataxia type 1 (SCA-ATXN1) is an autosomal dominant, neurodegenerative disease, caused by CAG repeat expansion in the ataxin-1 gene (ATXN1). In isolated reports of patients with neurological signs [symptomatic patients (SP)], macular abnormalities have been described. However, no reports exist about macular anomalies in SCA1 subjects carrying the ATXN1 mutation without neurological signs [not symptomatic carriers (NSC)]. Therefore, the main aim of our work was to evaluate whether the macular functional and morphological abnormalities could be detectable in SP, genetically confirmed and with neurological signs, as well as in SCA-ATXN1-NSC, harboring pathogenic CAG expansion in ATXN1. In addition, we investigated whether the macular involvement could be associated or not to an impairment of RGCs and of their fibers and of the neural conduction along the visual pathways. Herein, nine SCA-ATXN1 subjects (6 SP and 3 NSC) underwent the following examinations: visual acuity and chromatic test assessments, fundus oculi (FO) examination, macular and peripapillary retinal nerve fiber layer thickness (RNFL-T) analysis by Spectral domain-Optical Coherence Tomography (Sd-OCT) acquisition, multifocal electroretinogram (mfERG), pattern reversal electroretinogram (PERG) and visual evoked potentials (VEP) recordings. In four eyes of two SP, visual acuity reduction and chromatic abnormalities were observed, in three of them FO changes associated with macular thinning and outer retinal defects were also detected. In three NSC eyes, slight FO abnormalities were associated with qualitative macular morphological changes. By contrast, abnormal mfERG responses (exclusively from foveal and parafoveal areas) were detected in all SP and NSC (18 eyes). No abnormalities of PERG values, RNFL-T, and VEP responses were found, but in one SP, presenting abnormal papillo-macular bundle neural conduction. Results from our SCA-ATXN1 cohort suggest that a macular dysfunction, detectable by mfERG recordings, may occur in the overt disorder, and unexpectedly in the stage of the disease in which there is still an absence of neurological signs. In NSC, an exclusive dysfunction of preganglionic macular elements can be observed, and this is associated with both normal RGCs function and neural conduction along the visual pathways.

Purpose To improve structure-function analysis in primary open-angle glaucoma (POAG) by including the two-global flash multifocal electroretinogram (2F–mfERG) and macular ganglion cell layer segmentation. Methods Twenty-five glaucoma patients (six pre-perimetric (PPG), 19 POAG) and 16 controls underwent 2F–mfERG, optical coherence tomography (OCT), and standard automated perimetry (SAP). For 2F–mfERG, the root mean square was calculated for the focal flash response at 15–45 ms (DC) and the global flash responses at 45–75 ms (IC1) and 75–105 ms (IC2). For OCT, macular total thickness (mT) and ganglion cell-inner plexiform layer (GCIPL) thickness were analysed. Values from the central 10° and 15° of 2F-mfERG were compared to the corresponding areas from OCT and visual field. Results Both PPG and POAG had significantly lower mfERG responses in the central 10° and 15° than the control group. Of the glaucoma patients, 30.7% (three PPG, five POAG) showed central mfERG and GCIPL reduction without a SAP defect in the central 15 degrees. Four patients had a central SAP defect associated with a reduced GCIPL without any detectable dysfunction on mfERG. MfERG DC and IC2 were larger with increased mT (p ≤ 0.02), but GCIPL only related positively to IC2 (p = 0.027). SAP sensitivity also increased with thicker mT but not with GCIPL (p

Purpose To further improve analysis of the two-flash multifocal electroretinogram (2F-mfERG) in glaucoma in regard to structure–function analysis, using discrete wavelet transform (DWT) analysis. Methods Sixty subjects [35 controls and 25 primary open-angle glaucoma (POAG)] underwent 2F-mfERG. Responses were analyzed with the DWT. The DWT level that could best separate POAG from controls was compared to the root-mean-square (RMS) calculations previously used in the analysis of the 2F-mfERG. In a subgroup analysis, structure–function correlation was assessed between DWT, optical coherence tomography and automated perimetry (mf103 customized pattern) for the central 15°. Results Frequency level 4 of the wavelet variance analysis (144 Hz, WVA-144) was most sensitive (p

Clinical ophthalmology Volume 11, 621-629 (2017). doi:10.2147/OPTH.S123513, Published by Dove Medical Press, Auckland, New Zealand

Purpose: To evaluate the intermediate and outer retina of patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) using OCT and multifocal electroretinography (mf-ERG).Methods: Patients with MS (n = 30), NMOSD (n = 30), and healthy controls (n = 29) underwent visual field (VF), OCT, and mf-ERG testing. The eyes were distributed into 5 groups: MS with or without history of ON (MS+ON, MS–ON), NMOSD with or without ON (NMOSD+ON, NMOSD–ON), and controls. The thickness of the macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer, outer plexiform layer, outer nuclear layer, and photoreceptor layer was measured. mf-ERG P1 and N1 responses were registered and grouped in 3 sets of rings. The groups were compared using GEE models, and effect size (ES) calculated.Results: Compared to controls, GCL and IPL thickness was significantly smaller in MS+ON (both p < 0.01), MS–ON (p < 0.01 and p = 0.015, respectively), NMOSD+ON (both p < 0.01) and NMOSD–ON (p = 0.03 and p = 0.018, respectively). ES was >0.80. mRNFL was smaller in three of the above groups (p < 0.01, p < 0.001, and p = 0.028; ES > 0.80) but not in MS–ON eyes (p = 0.18). No significant difference was observed for the remaining layers. Compared to controls, P1 and N1 peak times were shorter in MS (p-values in the range 0.049–0.002, ES < 0.50; and 0.049–0.010; ES < 0.50, respectively) but not in NMOSD. These abnormalities were strongly correlated with intermediate and outer retinal layer thickness.Conclusions: mf-ERG data suggest outer retinal abnormalities in MS, but not in NMOSD. Our results may help understand how the two conditions differ regarding retinal damage.

Debido a la alta prevalencia de enfermedades maculares y al aumento de esta tiene una gran importancia el analizar las pruebas que tengan utilidad para medir la función visual de estos pacientes, para los cuales la agudeza visual no puede ser el parámetro de referencia debido al escotoma central que presentan. El objetivo de este estudio es analizar las diferentes pruebas que pueden utilizarse en ensayos clínicos para medir la función visual de pacientes con patología macular., Grado en Óptica y Optometría

Purpose The aim was to assess early functional and structural changes in the neural retina in type 2 diabetic patients with no clinical signs of diabetic retinopathy (DR). Patients and methods A total of 92 eyes of 48 patients were included, which were divided into the following groups: 30 eyes of 16 participants with type 2 diabetes mellitus without clinical DR, with a mean age of 48.75±3.09 years, as group 1; 30 eyes of 16 participants with type 2 diabetes mellitus with DR, with a mean age of 51.75±2.86 years, as group 2; and a control group of 32 eyes of 16 healthy age-matched and sex-matched participants, with a mean age of 49.88±4.26 years. After full ophthalmologic examination, spectral-domain optical coherence tomography scans, multifocal electroretinogram (Mf-ERG), pattern electroretinogram (PERG), and photonegative response (PhNR) were tested for all participants. Statistical analysis was performed to compare ganglion cell complex (GCC) thicknesses, multifocal electroretinogram, PERG, and phNR values between the groups. Results There were no statistically significant differences between the studied groups regarding age, sex, refraction, or intraocular pressure (P=0.056,0.72, 0.16, and 0.35, respectively). There were significant differences of total GCC thickness values among group 1 (107.13±7.04 μm), group 2 (97.27±10.97 μm), and control group (113.81±5.26 μm) (P

Purpose: To report a case of acute zonal occult outer retinopathy (AZOOR) in a 39-year-old woman. Methods: Images were obtained with fundus photography and optical coherence tomography (OCT). A multifocal electroretinogram (mfERG) was also obtained to evaluate retinal function. Results: The patient's right visual acuity was 0.8. Fundus photographs showed no specific abnormal findings. OCT showed attenuation of the photoreceptor inner segment/outer segment (IS/OS) line and the cone outer segment tip (COST) line in the right eye. The mfERG showed corresponding amplitude reductions. One month after the initial visit, her right visual acuity improved to 1.2. There was partial recovery of the IS/OS line; however, the COST line was still absent, and there was no apparent improvement in the mfERG responses. Conclusions: Our findings showed a discrepancy between the microstructural findings and visual function during recovery of AZOOR.

Purpose: To evaluate peripapillary acute zonal occult outer retinopathy in a 67-year-old man. Methods: Images were obtained using fundus photography, fluorescein angiography (FA) and indocyanine green angiography (ICGA), fundus autofluorescence (FAF) imaging, and optical coherence tomography (OCT). Visual field testing and multifocal electroretinogram (mfERG) were also performed to evaluate retinal function. Results: Fundus photographs showed subtle pigmentary changes in the peripapillary region, while FAF imaging showed clearly defined hypofluorescent areas in the peripapillary region. Intense hyperfluorescent lesions were also seen underneath hypofluorescent areas. A transmission defect with a granular hyperfluorescence was visible on FA, and ICGA showed hypofluorescence within the lesion. The outer border of the peripapillary zone appeared to block the underlying choroidal fluorescence. The photoreceptor inner segment/outer segment line was absent on OCT images from this area in both eyes, and hyperreflective punctate drusen-like materials were present at the outer border of the peripapillary zone. Visual field testing by Goldmann perimetry showed blind-spot enlargement, and mfERG showed corresponding amplitude reductions. Conclusions: We speculate that the intense hyperautofluorescent material at the outer border of the peripapillary zone might be accumulated drusenoid lipofuscin.

The spatial variation in central retinal function determined from mfERG was compared to co-localised measurements of cone density in two normal subjects. Individual cone cells in the parafoveal region of the retina were identified from 1 degrees x1 degrees images of the photoreceptor mosaic using a modified Heidelberg retina tomograph (HRT). The variation in cone density compared well with previous histology and retinal imaging studies and was strongly linearly correlated (r=0.98, p

Purpose To examine a female subject, her father, and a brother harboring a missense mutation of the retinitis pigmentosa 1-like 1 (RP1L1) gene, over 2 years of follow-up. Design Observational case series. Methods setting: Fondazione G.B. Bietti IRCCS, Rome, Italy. study population: RP1L1 family members and controls. main outcome measures: Images of the cone mosaic acquired with an adaptive optics retinal camera, spectral-domain optical coherence tomography (SD OCT), and full-field and multifocal electroretinography (mfERG). Results In the proband, best-corrected visual acuity (

Ocular manifestations of Noonan syndrome (NS) in a set of healthy 20-year-old African-American fraternal twins are reported with emphasis on a rare finding of keratoconus with acute corneal hydrops in one twin. Both the twins had learning disabilities and attended a special needs school. Evaluation included visual acuity assessment, tonometry and external eye, slit lamp and dilated fundus examinations, topography with Pentacam and external photographs. The first case was more remarkable as keratoconus with acute corneal hydrops was observed. The patient presented with severe cloudy vision that had worsened over a span of 1 month. It improved significantly on follow-up. The second case included a unique constellation of ocular pathology that highlights the diversity of NS manifestations even amongst twins. Conservative treatment of keratoconus with acute corneal hydrops in a NS patient helped largely resolve the patient's condition. We report the diverse spectrum of ocular manifestations associated with this rare congenital disorder.

Purpose: Oscillatory potentials have been suggested to arise frorri the inner retina at the level of amacrine cells and inner plexiform layer and they are thought to provide a non-invasive assessment of inner retinal function. We sought to investigate the response dynamics of the inner retina of adult ernmetropes and myopes by analysing the oscillatory potentials of the multifocal electroretinograin (mfERG) in these groups. Methods: Eleven emmetropes and 18 myopes underwent mfERG testing using VERIS 5.1.5X. Myopes were further separated based on whether their myopia was stable (n = 9) or progressing (n = 9). Oscillatory potentials were recorded using a modified mfERG stimulation technique, the slow flash paradigm, and they were extracted using band-pass filtering from 100 to 300 Hz. The slow flash mfERG stimulus array consisted of 103-scaled hexagons and flickered according to a pseudorandom binary m-sequence (2(13-)1). Amplitudes and implicit times of the first-order oscillatory potentials were analysed. Results: There were significant differences in the implicit time of the oscillatory potentials of the emmetropes, stable myopes and progressing myopes (F-2,F-25 = 3.663, p = 0.043). Progressing myopes had significantly shorter implicit times compared to emmetropes (p = 0.026 by 1.0-4.7 ms) and stable myopes (p = 0.043 by 0.8-1.3 ms), whereas implicit times of stable myopes and emmetropes were similar. There were no statistically significant differences in amplitude of the oscillatory potentials between the groups (F-2,F-25 = 0-890, p = 0.426). Conclusions: Significant differences in multifocal oscillatory potentials between stable and progressing myopes were found. This finding is further evidence of an inner retinal involvement in human myopia progression and may suggest an underlying alteration to dopaminergic or GABAergic retinal systems.

Purpose The purpose of this study was to investigate the characteristics of retinal function in myopes using a modified multifocal electroretinogram (mfERG) protocol, the slow flash (sf-mfERG) paradigm, which is thought to primarily reflect responses of ON- and OFF-bipolar cells and emphasize the late response components. Methods Twenty-eight subjects (10 emmetropes and 18 myopes) underwent mfERG testing using VERIS 5.1.5X. The sf-mfERG stimulus array consisted of 103-scaled hexagons and flickered according to a pseudorandom binary m-sequence (213-1). The stimulation sequence was slowed by inserting three dark frames such that each step in the m-sequence was four frames long (53.3 ms). The amplitude and implicit time of the major sf-mfERG waveform features (N1, P1, and N2) of the first-order kernel were analysed. Results Myopes had significantly reduced P1 and N2 amplitudes compared to the emmetropes (F1, 25 = 8.818, p = 0.007; F1, 25 = 6.723, p = 0.017). There were no significant differences in N1 amplitude or implicit time between the groups (F1, 25 = 1.506, p = 0.233; F1, 25 = 1.291, p = 0.269). Conclusions Late response components (P1 and N2) of the first-order sf-mfERG responses were preferentially affected in myopia, suggesting possible reduced ON- and OFF-bipolar cell activity. As bipolar cells form the first synapse of the visual system with the photoreceptors to initiate the ON- and OFF-pathways, future investigations of ON- and OFF-systems in myopia are of interest.

It has been suggested that changes in the multifocal electroretinogram (mfERG) responses in myopes are primarily due to the increased axial length that accompanies myopia development. We investigated the characteristics of mfERG responses between emmetropes and myopes and determined the contribution of axial length to the mfERG data in 30 subjects (10 emmetropes and 20 myopes) using VERIS I. The amplitude and implicit time of the first positive peak (P1) of the first-order kernel were analyzed. We found that P1 implicit time in myopes was significantly longer by 1.3–3.1ms than that of the emmetropes and this was not explained by the myopes having greater axial lengths than the emmetropes. Axial length contributed to 15% of the implicit time total variance while refractive error accounted for 27%. Delayed mfERG responses observed in myopes were not attributable to the anatomical change that accompanies myopia and may suggest underlying differences in retinal function that result from being myopic.

The multifocal electroretinogram (mfERG) has been commonly used as a method for obtaining objective visual fields. Although qualitative comparisons have been good, quantitative comparisons between the results from mfERG and the results from Humphrey Visual Field Analyser (HVFA) have found variable degrees of agreement depending upon the mfERG response parameter examined and/or the disease studied. Lack of agreement may be due to differences in methodology, differences in the sites of response generation, and/or differences derived from comparing suprathreshold versus threshold responses. In addition, the two procedures are performed at different levels of adaptation. We developed an approach for matching stimulus parameters and compared mfERG and psychophysical thresholds to assess the effects of technique and level of adaptation on the two responses. Psychophysical and mfERG thresholds were obtained as a function of the adaptation level (1.5–4.0 log td) and retinal location. The derived increment threshold-versus-intensity functions for both measures were fitted using the equation log T =log T 0 +log(( A + A 0 )/ A 0 ) n . We found that the values of A 0 for the mfERG data were one log unit higher than those for the psychophysical data. In addition, the value of the slope ( n ) for the mfERG data was shallower (0.8) than that of the psychophysical data (1.0). Predictions were made about comparisons of HVFA threshold and mfERG amplitude data in patients with retinal disease based upon a two-site model of adaptation. The data for some groups of patients could be best-fitted with a model of a disease acting at a site distal to all gain changes, whereas data from other patients were best fitted with a model of a disease acting at a site proximal to all retinal gain. The relationship between the Humphrey visual field threshold losses and mfERG amplitude reductions depends upon the site and mechanism of a particular disease process and the model of retinal gain assumed. In no case is a one-to-one relationship between the losses in the two measures predicted.

AIM: To investigate the changes of retinal function in non-pathological myopic subjects using multifocal electroretinography (mfERG) and to correlate the data with the central macular thickness obtained using optical coherence tomography (OCT). METHODS: One hundred and thirteen subjects (113 eyes) with age range from 18 to 35y were enrolled in the study. The subjects were divided into four groups according to spherical equivalent (SE) and axial length (AL): emmetropia group (EG, n=31; SE: +0.75 to -0.50 D; AL: 22 to 24 mm), low and medium myopia group (LMMG, n=26; SE: ＞-0.50 to -6.00 D; AL: ＞24 to 26 mm), high myopia group (HMG, n=34; SE: ＞-6.00 to -10.00 D; AL: ＞26 to 28 mm) and super high myopia group (SHMG, n=22; SE: ＞-10.00 D; AL:＞28 mm). The P1 amplitude density, P1 amplitude, and P1 implicit time of the first-order kernel mfERG responses were obtained and grouped into five rings. The central subfield macular thickness (CST) was obtained using macular cube 512×218 scan of Cirrus HD-OCT. RESULTS: With the increasing of eccentricity, the first positive peak (P1) amplitude density (P=0.0000, 0.0001, 0.0021 in ring 1-3 respectively) and P1 amplitude (all P=0.0000 in ring 1-5) of each group decreased. With the increasing of myopia, P1 implicit time gradually extended (all P=0.0000 in ring 1-3). The average CST in four diagnostic groups was 241.56±12.72 μm, 244.56±12.19 μm, 254.33±11.61 μm, 261.75±11.83 μm respectively. With the increasing of myopia, CST increased (P

Occult macular dystrophy is an inherited macular dystrophy characterized by a progressive decline of bilateral visual acuity with normal fundus appearance, fluorescein angiogram and full-field electroretinogram. This case report presents a 20-year-old female patient with bilateral progressive decline of visual acuity for six years. Her visual acuity was 3-4/10 in both eyes. Anterior segment and fundus examination, fluorescein angiogram and full-field electroretinogram were normal. She could read all Ishihara pseudoisochromatic plates. Fundus autofluorescence imaging was normal. There was a mild central hyporeflectance on fundus infrared reflectance imaging in both eyes. Reduced foveal thickness and alterations of the photoreceptor inner and outer segment junction were observed by optical coherence tomography in both eyes. Central scotoma was also found by microperimetry and reduced central response was revealed by multifocal electroretinogram in both eyes. These findings are consistent with the clinical characteristics of occult macular dystrophy.

The association of macular detachment with posttraumatic macular hole is a known but rare occurrence. Spontaneously occurring resolution of the detachment and closure of the macular hole has been reported only once in the literature. We describe a similar rare event in a young male, the documentation of which was done serially by microperimetry (MP) and optical coherence tomography (OCT). A 17-year-old male presented with a decrease in vision following a closed globe injury to the left eye. A coexisting macular hole and macular detachment were detected in the affected eye. Serial follow-up with OCT and MP documented complete resolution of the macular hole and the macular detachment within 1 week of presentation. The case highlights that spontaneous resolution of traumatic macular hole and related macular detachment may occur and a waiting period is advisable before undertaking any corrective surgical procedure. The pathophysiologic mechanisms of causation and the resolution of posttraumatic macular hole-related retinal detachment are discussed.

Hereditäre Netzhauterkrankungen stellen eine heterogene Gruppe von Netzhauterkrankungen dar, deren Klinik sehr unterschiedlich sein kann. Bei der überwiegenden Mehrzahl der hereditären Netzhautdystrophien sind vor allem die Photorezeptoren (Stäbchen und Zapfen) und das retinale Pigmentepithel betroffen. Erkrankungen der Stäbchen führen zu Nachtsehstörungen und peripheren Gesichtsfeldausfällen, Zapfenerkrankungen zu Farbsinnstörungen, Visusminderung, Blendungsempfindlichkeit und zentralen Gesichtsfeldausfällen. In der Literatur liegt eine Reihe von Arbeiten, die sich mit spezifischen Netzhautdystrophien befassen, vor. Eine vergleichbare Studie, die eine große Zahl verschiedener Makula- und Zapfendystrophien mit einer konstanten Technik untersucht hat, existiert nicht. Ziel dieser Arbeit ist, die klinische Wertigkeit des mfERGs hinsichtlich Variabilität und Differentialdiagnostik bei der Untersuchung von Netzhautdystrophien mit zentraler Funktionsstörung, also Makula- und Zapfendystrophien, zu analysieren. Diese retrospektive Arbeit untersucht die Krankengeschichten von 186 Patienten der Augenklinik des Universitätsklinikums Benjamin Franklin in Berlin in einem Zeitraum von acht Jahren (1993 – 2001). Dabei wurden 261 von 372 möglichen Augen untersucht. Gründe hier für waren unter anderem artefaktreiche Ableitungen, Wünsche des Patienten oder Blindheit eines Auges. Das mfERG ist eine spezielle Methode, um lokalisierte Netzhautbezirke vor allem in der Makula zu untersuchen und erfasst lokalisierte Reizantworten im Bereich der Makula. Sie ist eine relativ neue elektrophysiologische Methode, mit der die Makula in circa sieben Minuten (ohne Vorbereitungszeit) analysiert werden kann. Unter multifokalen Reizbedingungen können Stäbchen, Zapfen, Ganglienzellen und Bipolarzellen zur Reizantwort beitragen. Die Aufgabe bestand darin, das mfERG für jedes Auge eines Patienten auszuwerten. Hierzu wurden in einer VERIS-Datenbank Kurven aufgerufen, die Mittelwerte der Kurven in ringförmigem Abstand um die Fovea angewählt und für jede der einzelnen Kurven Werte für die Amplitude der B-Welle P1, für die Gipfelzeit der A-Welle N1 und für die Gipfelzeit der B-Welle P1 erhoben. Somit wurden bei fünf Kurven 15 Werte erfasst. Die Ergebnisse des mfERGs zeigen teilweise unterschiedliche funktionelle Störungen bei verschiedenen Makuladystrophien. Der Vergleich der Ergebnisse des mfERGs bei den verschiedenen Makuladystrophien zeigt, dass eine deutliche Diskrepanz zwischen morphologischen und funktionellen Änderungen bestehen kann. Vom klinischen Befund zu erwarten war, dass die Funktionsausfälle bei der zentralen areolären Aderhautdystrophie und dem M. Stargardt am stärksten ausgeprägt sind. Unerwartet ist die geringe Funktionsstörung bei den hereditären Drusen im Vergleich zur adulten vitelliformen Makuladystrophie, obwohl erstere in der Regel ein wesentlich größeres Areal als nur die zentrale Fovea betreffen. Darüber hinaus ist die Art der Funktionsstörung des Zapfensystems bei den verschiedenen Makuladystrophien offenbar unterschiedlich. Allerdings bleibt unklar, warum es beim M. Best in dieser und anderen Untersuchungen in einem wesentlich größeren Areal zu Latenzverzögerungen kommt, aber nicht zu Amplitudenreduktionen. Die Latenzverzögerungen finden sich in Arealen, die morphologisch unauffällig erscheinen. Umgekehrt zeigten die hereditären Drusen, ebenfalls eine Erkrankung vorwiegend unterhalb des Pigmentepithels und Photorezeptoren ähnlich dem M. Best, in Bereichen deutlicher morphologischer Veränderungen keine Funktionsausfälle im mfERG. Zapfendystrophien führen zu einer deutlich stärkeren, mit dem mfERG nachweisbaren Funktionsstörung als Makuladystrophien sowohl in Bezug auf die Ausprägung der Amplitudenreduktion als Zeichen für die Zapfenfunktion als auch in Bezug auf die Latenzverzögerung als Zeichen der Informationstransmission im Zapfensystem. Die Ergebnisse zeigen, dass das mfERG geeignet ist, die regionalen Funktionsstörungen am hinteren Augenpol bei hereditären Netzhauterkrankungen mit vorwiegender Beteiligung des Zapfensystems zu differenzieren. Eine Differentialdiagnose verschiedener Makuladystrophien oder Zapfendystrophien ist mit dem mfERG nicht möglich. Eine Ausnahme stellt das Enhanced S Cone Syndrom dar, bei dem die Verteilung der Latenzen mit zunehmender Exzentrizität charakteristisch ist. Die unterschiedlichen Ergebnisse des mfERGs bei den verschiedenen Makuladystrophien zeigen jedoch, dass die Korrelation zwischen morphologischen Veränderungen und Funktionsausfällen nicht immer nachvollziehbar ist. Zusammengefasst erlaubt das mfERG eine Differenzierung zwischen Makuladystrophien und Zapfendystrophien, eine spezifische Diagnose eines Enhanced S Cone Syndroms und eine detaillierte und differenzierte Definition von regionalen Funktionsstörungen am hinteren Augenpol bei hereditären Netzhauterkrankungen mit vorwiegender Beteiligung des Zapfensystems., Hereditary retinopathies represent a heterogenic group of retinal diseases which can have a very different symptomatic complex. Most of the hereditary retinal dystrophies affect the photoreceptors (rods and cones) and the retinal pigmentary epithelium. Cone diseases result in nocturnal disturbance of vision and losses of the peripheral visual field, rod diseases result in disturbances concerning the colour sense, impaired vision, sensitivity for blinding and losses of the central field. Literature presents a range of publications concerning specific retinal diseases but a comparable survey analysing a great number of different macula- and cone dystrophies by using a constant technology does not exist. The aim of this dissertation is to analyse the clinical validity of the multifocal electroretinogram regarding variability and differential diagnostics of the examination of retinal dystrophies with central dysfunction (= macula- and cone dystrophies). This retrospective survey looks at the clinical history of 186 patients who visited the ophthalmic clinic of the University Hospital Benjamin Franklin in Berlin in the years from 1996 until 2001. 261 of 372 eyes were able to be examined. The reason why only 261 eyes were able to be examined was that the recordings of the multifocal electroretinogram were too artifactual, amongst this blindness of an eye or the certain requests of a patient played a major role. The multifocal electroretinogram is a special method to examine local retinal areas above all macula dystrophies and captures local stimulus responses. The multifocal electroretinogram ia a relatively new electrophysiological method to examine the macula within about seven minutes (without preparation time). With the multifocal electroretinogram rods, cones, ganglion cells and bipolar cells can be stimulated. The purpose of this dissertation was to evaluate the multifocal electroretinogram of every eye. For this purpose curves were activated in a VERIS data bank, the average value of the curves were selected in a circular distance to the fovea and for each of the curves the results for the amplitude of the B-wave P1, for the peak time of the A-wave N1 and for the peak time of the B-wave P1 were acquired. Therefore 15 data were acquired for five curves. The results of the multifocal electroretinogram show partially different functional disorders for the different macula dystrophies. It shows comparing the results of the multifocal electroretinogram of the different macula dystrophies that there can be a distinct discrepancy between morphological and functional changes. Concerning the medical findings we expected that the functional failures were worst of all for the central areolar choroidal dystrophy and for the Stargardt’s disease. Surprisingly there is a minimal functional failure for the hereditary drusen comparing them with the adult vitelliform macula dystrophy although the hereditary drusen affect a much bigger area than only the central fovea. On top of that the kind of functional failure concerning the cone system of every different macula dystrophy is apparently different. Nevertheless it remains unclear why in this and in other surveys in a much bigger area there are delays for the latency but no decreasing of the amplitude for the Best’s disease. The latency delays are found in areas with normal morphology. To the contrary the hereditary drusen, a disease mainly having affects under the pigmentary epithelium and on the photoreceptors similar to the Best’s disease, showed in the multifocal electroretinogram no functional losses in areas of distinct morphological alteration. Cone dystrophies lead to a much greater provable loss of function in the multifocal electroretinogram than macula dystrophies concerning the manifestation of the decreasing of the amplitude as a sign for the cone function as well as the delay for the latency as a sign for the transmission of the information in the cone system. The results show that the multifocal electroretinogram is suitable to make precise distinctions of regional functional disorders of hereditary retinopathies which mainly have affects on the cone system. A differential diagnosis of the different macula dystrophies or cone dystrophies is not possible. Except for the enhanced S cone syndrome: the distribution of the latencies with increasing eccentricity is characteristic. The varying results of the multifocal electroretinogram for the different macula dystrophies reveal however that the correlation between morphological changes and functional losses cannot always be comprehensible. Summarized the multifocal electroretinogram allows a distinction between macula dystrophies and cone dystrophies, a specific diagnosis of a enhanced S cone syndrome and a detailed and differentiated definition of regional functional disorders of hereditary retinopathies mainly concerning the cone system.

This is a rare case of persistent Horner's syndrome following epidural anesthesia and Caesarean section. A 33-year-old female presented with persistent ptosis and miosis following epidural anesthesia and Caesarian section several months prior. Magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) of head, neck, and chest were unremarkable. Medline search using terms Horner's, epidural, spinal anesthesia, delivery, childbirth, Caesarian, and pregnancy identified 31 articles describing Horner's syndrome in obstetric epidural anesthesia, of which 11 were following Caesarean section. The increased incidence of Horner's syndrome in the setting of epidural anesthesia in pregnancy may be related to epidural venous engorgement and cephalic spread of the local anaesthetic, with disruption in the oculosympathetic pathway. It is important to include recent epidural anesthesia within the differential diagnosis of acute Horner's syndrome in a postpartum female. Rarely, the ptosis may be permanent and require surgical intervention.

Purpose: To study the susceptibilities of Aspergillus species against amphotericin B in infectious keratitis and to find out if drug resistance had any association with the molecular characteristics of the fungi. Materials and Methods: One hundred and sixty Aspergillus isolates from the corneal scrapings of patients with keratitis were tested for susceptibilities to amphotericin B by broth microdilution method. These included Aspergillus flavus (64 isolates), A. fumigatus (43) and A. niger (53). Fungal DNA was extracted by glass bead vertexing technique. Polymerase chain reaction (PCR) assay was standardized and used to amplify the 28S rRNA gene. Single-stranded conformational polymorphism (SSCP) of the PCR product was performed by the standard protocol. Results: Of the 160 isolates, 84 (52.5%) showed low minimum inhibitory concentration (MIC) values (≤ 1.56 μg/ml) and were designated as amphotercin B-sensitive. Similarly, 76 (47.5%) had high MICs (≥ 3.12 μg/ml) and were categorized as amphotericin B-resistant. MIC 50 and MIC 90 values ranged between 3.12-6.25 μg/ml and 3.12-12.5 μg/ml respectively. A. flavus and A. niger showed higher MIC 50 and MIC 90 values than A. fumigatus . The SSCP pattern exhibited three extra bands (150 bp, 200 bp and 250 bp each) in addition to the 260 bp amplicon. Strains (lanes 1 and 7) lacking the 150 bp band showed low MIC values (≤ 1.56 μg/ml). Conclusion: A. niger and A. flavus isolates had higher MICs compared to A. fumigatus , suggesting a high index of suspicion for amphotericin B resistance. PCR-SSCP was a good molecular tool to characterize Aspergillus phenotypes in fungal keratitis.

To compare and to evaluate the use of the multifocal electroretinography (mfERG) to conventional systems in assessing early changes of the retinal electric signals in patients with ocular dysfunction due to antimalarial drug therapy.This article represents an up-to-date review of the current thoughts regarding the mfERG technique and its use in providing a topographic measure of the retinal electrophysiological activity.Various investigations have been suggested to be useful in the assessment of toxic retinopathy, but, since they involve subjective responses by the patients and lack of sensibility, the mfERG may be particularly useful for documenting early toxic retinopathy.A small percentage of patients face retinal functional alterations and ocular lesions and that is possible thanks to the use of lower dosages of hydroxychloroquine (Hy) and chloroquine (CQ), but the problem still remains because of the cumulative dose of the drugs in therapy that many of these patients go through. The mfERG can be considered a good method of early detection and tracking of the progression of macular changes of retinopathy and could occupy a key position in assessing macular changes in patients on antimalarial drug therapy.

Purpose First, to examine both the reproducibility of the multifocal electroretinogram (mfERG) recorded on different versions of the same instrument, and the repeatability of the mfERG recorded on a single instrument using two different amplifiers. Second, to demonstrate a means by which multicenter and longitudinal studies that use more than one recording instrument can compare and combine data effectively. Methods Three different amplifiers and two mfERG setups, one using VERIS™ 4.3 software (mfERG1) and another using VERIS™ Pro 5.2 software (mfERG2), were evaluated. A total of 73 subjects with normal vision were tested in three groups. Group 1 (n = 42) was recorded using two amplifiers in parallel on mfERG1. Group 2 (n = 52) was recorded on mfERG2 using a single amplifier. Group 3 was a subgroup of 21 subjects from groups 1 and 2 that were tested sequentially on both instruments. A fourth group of 26 subjects with diabetes were also recorded using the two parallel amplifiers on mfERG1. P1 implicit times and N1-P1 amplitudes of the 103 local first order mfERGs were measured, and the differences between the instruments and amplifiers were evaluated as raw scores and Z-scores based on normative data. Measurements of individual responses and measurements averaged over the 103 responses were analyzed. Results Simultaneous recordings made on mfERG1 with the two different amplifiers showed differences in implicit times but similar amplitudes. There was a mean implicit time difference of 2.5 ms between the amplifiers but conversion to Z-scores improved their agreement. Recordings made on different days with the two instruments produced similar but more variable results, with amplitudes differing between them more than implicit times. For local response implicit times, the 95% confidence interval of the difference between instruments was approximately ±1 Z-score (±0.9 ms) in either direction. For local response amplitude, it was approximately ±1.6 Z-scores (±0.3 μV). Conclusions Different amplifiers can yield quite different mfERG P1 implicit times, even with identical band-pass settings. However, the reproducibility of mfERG Z-scores across recording instrumentation is relatively high. Comparison of data across systems and laboratories, necessary for multicenter or longitudinal investigations, is facilitated if raw data are converted into Z-scores based on normative data.

We investigated relationships between retinal structure using optical coherence tomography (OCT) and retinal function using peripheral resolution acuity and multifocal electroretinograms (mfERG) in 56 subjects with a range of refractive errors (+0.50 to −15.00D). Retinal thinning occurred in moderate and high myopia which appeared to be primarily due to reduced thickness of the middle to inner retina (MIR) (outer plexiform layer to the nerve fiber layer). MIR thickness was correlated with reduced spatial resolution and delayed mfERG timing in the peripheral retina. The findings suggest the structure and function of the post-receptor retina is susceptible to disruption in moderately and highly myopic eyes.

espanolObjetivo: Determinar la utilidad del electrorretinograma multifocal (mfERG) en la evaluacion clinica de la respuesta al tratamiento con terapia fotodinamica (TFD) en pacientes con neovascularizacion coroidea (NVC) secundaria a degeneracion macular asociada a la edad (DMAE). Metodos: Se ha realizado un estudio prospectivo en 23 ojos de 22 pacientes con NVC predominantemente clasica. Al inicio se realizo una medicion de la agudeza visual mediante optotipos de Colenbrander, exploracion biomicroscopica (BMC), retinografia, angiografia fluoresceinica (AGF), campimetria de Humphrey 24-2 y mfERG. Todos los pacientes fueron tratados mediante TFD. Se ha repetido la exploracion de la agudeza visual, BMC, campimetria y mfERG a los dos y a los seis meses del tratamiento y se ha realizado una AGF tras un intervalo entre los cuatro y seis meses del inicio del estudio. Resultados: La agudeza visual permanece estable o mejora en todos los pacientes incluidos en el estudio. El estudio campimetrico nos ofrece resultados erraticos y poco fiables debido a la mala fijacion que presentan estos pacientes. La densidad de respuesta de las ondas N1 y P1 del mfERG en los anillos centrales no muestra variaciones significativas despues del tratamiento, sin embargo mejora en los anillos 3 (p=0,000), 4 y 5 (p=0,008). Conclusiones: El mfERG es una prueba de utilidad en el seguimiento de la NVC puesto que nos permite medir objetivamente la sensibilidad retiniana en pacientes con maculopatias tratadas con terapia fotodinamica. Por otra parte obtenemos un mapa de sensibilidades de la retina central en el que podemos valorar la extension y la profundidad de la lesion. EnglishPurpose: To assess the value of multifocal electroretinogram (mfERG) in clinical evaluation of the response of patients with choroidal neovascularization (CNV), secondary to age-related macular degeneration, to photodynamic therapy (PDT) Methods: We designed a prospective non-comparative case series and enrolled 23 eyes of 22 patients with predominantly classic CNV. The initial evaluation included clinical examination with measurement of visual acuity (Colenbrander), biomicroscopic evaluation (BMC), retinography, fluorescein angiography (FA), Humphrey 24-2 visual field examination and mfERG. All patients were treated with PDT. Clinical follow-up was performed two and six months after treatment with visual acuity evaluation, BMC, visual field assessment and mfERG. FA was repeated after an interval of between four and six months in all patients. Results: Visual acuity remained stable or improved in all patients included in the study. Visual field examination gave erratic and unreliable results because of patients’ unstable fixation. N1 and P1 wave peak amplitudes in the central rings did not change significantly after treatment but they improved in rings 3 (p=0.000), 4 and 5 (p=0.008). Conclusions: Multifocal ERG is a useful tool for the clinical follow-up of CNV. It offers interesting non-subjective data of retinal sensitivity of patients with macular diseases treated with PDT. In addition we obtained a central retinal sensitivity map where we were able to evaluate the extent and depth of retinal damage.

A 20-year-old man applied with vision loss in the left eye. Right eye examination was unremarkable. Best-corrected visual acuity (BCVA) in the left eye was 20/200. Fundus examination revealed a few yellow spots within a round-shaped macular lesion. Autofluorescence imaging showed hyperautofluorescence in the lesion. Central amplitudes in multifocal electroretinogram (mfERG) were depressed. The patient reported a rhinopharyngitis 7–10 days before the visual loss. The patient was diagnosed as acute retinal pigment epithelitis. BCVA improved gradually up to 20/20 in 4 weeks. mfERG amplitudes returned to normal. A slight pigmentary distortion was the only residual fundus finding.

Aim of the Study: To establish the normative database for multifocal electroretinogram (mfERG) parameters in a normal emmetropic population. To correlate the data so obtained with the central macular thickness obtained using the optical coherence tomography (OCT) scan. Materials and Methods: mfERG data were obtained from 222 eyes of 111 emmetropic subjects. The amplitude (nv/deg 2 ) and implicit times (ms) of the first-order kernel mfERG responses (N1, P1, and N2 waves) were obtained and grouped into five rings (Ring 1: Central 2°, Ring 2: 2-5°, Ring 3: 5-10°, Ring 4: 10-15°, Ring 5: >15°). The central macular thickness (CMT) was obtained using the macular thickness scan protocol of the OCT. Results: The mfERG data obtained were used to create a normative database. The amplitudes of the mfERG waves were maximum in the fovea and progressively decreased with increasing eccentricity (P = 0.0001). The latencies of the P1 and N2 waves were longest in the central ring and progressively shortened with eccentricity (P = 0.0001). No statistically significant correlations were observed between central ring 1 parameters and the CMT. Conclusion: This study establishes normative database for mfERG parameters in an emmetropic population. No statistically significant correlation was noted between CMT and mfERG parameters.

Anterior megalophthalmos, a rare hereditary disorder, is macrocornea (horizontal corneal diameter more than 13 mm) in association with enlarged lens-iris diaphragm and ciliary ring. One of the major challenging issues in the cataract surgery of these patients is preventing intraocular lens (IOL) malposition, because of probable large capsular bag. Several approaches have been selected by previous surgeons, such as, custom-made anterior chamber IOLs. In this study, we show a normal capsular bag diameter despite ciliary ring enlargement, with application of ultrasound biomicroscopy (UMB). We suggest that in cases of anterior megalophthalmos without phacodonesis, UBM could measure the actual size of the capsular bag and obviate the need for further procedures.

A 55-year-old woman, with history of cataract surgery 1 year back, presented with features of ocular inflammation for last 3 months. She had no history of any other intraocular surgery. On examination, anterior segment showed frothy material in the inferior angle with moderate anterior chamber reaction (cells+/flare+) and sulcus intraocular lens with large posterior capsule rent. Fundoscopy showed multiple, small to medium-sized transparent bubbles of perfluorocarbon liquid (PFCL) with membranes in the vitreous cavity. Ultrasonography confirmed the presence of PFCL in the vitreous cavity. Pars plana vitrectomy with anterior chamber wash was done which led to good visual recovery. To conclude, retained PFCL can cause late onset fibrinous inflammation after a quiescent period but surgical intervention may lead to good visual outcome.

We report a rare case of keratoconus with granular dystrophy with a follow-up of two decades, documenting the sequential presentation of two diseases confirmed by histology and genetic studies. A 13-year-old boy was diagnosed in 1988 with keratoconus in both eyes (BE) based on slit-lamp biomicroscopy findings of corneal ectasia in BE accompanied by Fleischer′s ring, Vogt′s striae, a small, old, healed hydrops. The left eye (LE) had central corneal thinning and scar in the central area involving the mid and posterior stroma secondary to healed hydrops. Penetrating keratoplasty (PKP) was advised. The boy was lost to follow-up till 1991 and presented with white, dot-like opacities in the central cornea in the RE only, suggestive of granular corneal dystrophy. Similar findings of white, dot-like opacities were noted in the LE in 1995 and the patient subsequently underwent PKP in BE. Histopathology of corneal buttons confirmed the presence of patchy, crystal-like orange deposits, which stained bright red with Masson′s trichrome. Mutational analysis of the TGFBI gene in patient′s DNA revealed a heterozygous mutation corresponding to a change in Arg555Trp in the keratoepithelin protein. Granular dystrophy recurred after 8 years in the RE.

Choroidal osteoma is an unusual form of intraocular calcification seen in otherwise healthy eyes. It is a benign idiopathic osseous tumor of the choroid, typically seen in young females. Choroidal neovascular membrane (CNVM) is a complication seen in one-third of these patients and carries a poor visual outcome. We report a case of a 25-year-old hyperthyroid female with choroidal osteoma and subfoveal CNVM in her left eye which was successfully treated using low-fluence photodynamic therapy (PDT) with verteporfin followed by a single injection of intravitreal ranibizumab.

Nasopalpebral lipoma-coloboma syndrome is characterized by nasopalpebral lipoma and eyelid coloboma. We report a case of a 16-year-old Indian girl who reported to us with this rare syndrome. Computed tomography scan showed a significantly hypodense lesion on the right side of nose which was confirmed to be a lipoma on histopathological examination. This condition should be included in differential diagnosis of conditions with congenital eyelid coloboma.

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.