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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.

AIM: To explore the characteristic changes of multifocal electroretinogram(mfERG)in strabismic amblyopia eyes with eccentric fixation.METHODS: A total of 20 patients with strabismus amblyopia and eccentric fixation visited our hospital from January 2018 to December 2020 were collected as the study group(4 patients with exotropia and 16 patients with esotropia), while 20 patients with ametropic amblyopia were collected as the control group. The mfERG was examined under the state of mydriasis, and the amplitude density and incubation period of P1 wave were recorded.RESULTS: Compared with the fellow eyes, the first ring(P=0.001), the second ring(P

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.

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.

Background Diabetic retinopathy and clinically significant macular edema are largely responsible for the irreversible, debilitating visual impairment. There is evidence suggesting that some of the diabetes-related visual abnormalities are due to neurodegeneration. Use of objective tests for early detection of retinal dysfunction of sight-threatening diabetic retinopathy would be of great value. Aim The aim was to study the functional improvements of macular functions after treatments with intravitreal injection of ranibizumab as detected with central visual field and multifocal electroretinogram (mfERG). Settings and design A prospective cohort interventional study that included 30 eyes of 30 patients. Materials and methods Prospective cohort interventional study including 30 eyes of 30 patients with nonproliferative diabetic retinopathy with diabetic macular edema who were treated with three doses of intravitreal injection of ranibizumab and then performed optical coherence tomography, Central visual field, and mfERG, to assess macular function as detected with visual acuity measuring by LogMAR acuity testing, central visual field and mfERG. Statistical analysis Parametric data were analyzed with analysis of variance and whenever appropriate with Student's t-test. Nonparametric data were analyzed with χ2 and/or Mann–Whitney tests. Statistical significance was considered at 95% confidence interval. All P values less than 0.05 was considered statistically significant. Results After treatment, visual acuity (VA) of 25 eyes improved, whereas five eyes showed stabilization of VA with the same central foveal thickness (CFT). All measurements of the CFT were decreased. The authors could find significant decreases in the average CFT from baseline (376.16 ± 66.23 months) to 261.58 ± 37.55 months at 3 months. Conclusion VA correlates closely with CFT and P1 amplitude in the central ring of the mf-ERG, where P1 amplitude shows higher sensitivity than with CFT based on optical coherence tomography.

Highlights • A computer-aided system for diagnosis of multiple sclerosis is implemented. • 40 features are obtained from the multifocal electroretinogram recordings. • The four most relevant features are selected using a filter and the wrapper selection method. • The classifier produces a Matthews correlation coefficient value of 0.89. • A promising new electrophysiological-biomarker method for diagnosis of multiple sclerosis is identified., The purpose of this paper is to implement a computer-aided diagnosis (CAD) system for multiple sclerosis (MS) based on analysing the outer retina as assessed by multifocal electroretinograms (mfERGs). MfERG recordings taken with the RETI‐port/scan 21 (Roland Consult) device from 15 eyes of patients diagnosed with incipient relapsing-remitting MS and without prior optic neuritis, and from 6 eyes of control subjects, are selected. The mfERG recordings are grouped (whole macular visual field, five rings, and four quadrants). For each group, the correlation with a normative database of adaptively filtered signals, based on empirical model decomposition (EMD) and three features from the continuous wavelet transform (CWT) domain, are obtained. Of the initial 40 features, the 4 most relevant are selected in two stages: a) using a filter method and b) using a wrapper-feature selection method. The Support Vector Machine (SVM) is used as a classifier. With the optimal CAD configuration, a Matthews correlation coefficient value of 0.89 (accuracy = 0.95, specificity = 1.0 and sensitivity = 0.93) is obtained. This study identified an outer retina dysfunction in patients with recent MS by analysing the outer retina responses in the mfERG and employing an SVM as a classifier. In conclusion, a promising new electrophysiological-biomarker method based on feature fusion for MS diagnosis was identified.

Background We aimed to assess early retinal changes in diabetic subjects without clinical retinopathy using multifocal electroretinogram (mfERG). Methods Twenty eyes of 20 diabetic subjects type 2 without retinopathy and 20 eyes of 20 healthy controls of the same age and sex were eligible for our study and underwent mfERG. MfERG responses were recorded; N1–P1 amplitude and P1 implicit time of the 5 rings recorded were measured and analyzed. Results The reduction in N1–P1 amplitude and the delay in P1-implicit time in type 2 diabetic subjects were statistically significant in most of the assessed rings compared to controls (p Conclusions Our study showed reduced mfERG N1–P1 amplitude and delayed P1-implicit time indiabetic patients without retinopathy compared to normal controls. Implicit time andamplitude were significantly affected by diabetes duration. These results propose a valuable role of mfERG in evaluating the expected neuroretinal dysfunction before the clinical development of diabetic retinopathy. Early detection of functional abnormalities indicates that the patients need more tight medical control of diabetes. More well-designed studies are needed to assert upon these results.

Multifocal electroretinogram(mf-ERG)is a common type of electroretinogram. It can objectively, accurately and quantitatively detect the function of each tiny part of the retina, so it is widely used in clinical, especially in retinal diseases. It not only plays an important role in the diagnosis and efficacy evaluation of retinal diseases, but also has an important value in the follow-up and prevention of diseases, even the scope of its application can be extended to basic research. Therefore, this paper reviews the application of multifocal electroretinogram in retinal diseases.

AIM:To evaluate the functional and structural changes of foveal macula after intravitreal ranibizumab injection in patients with macular edema secondary to branch retinal vein occlusion(BRVO-ME)and screen the factors that can predict the final visual acuity of the patients. METHODS: Prospective, clinical study. In this prospective single-arm study, we observed 25 patients(25 eyes)diagnosed with BRVO-ME who were enrolled from 2018.6-2019.5 in the first central hospital of Baoding. All patients received monthly ranibizumab 0.5mg injections for 3 consecutive months. The best-corrected visual acuity(BCVA),the central macular thickness(CMT)and the vessel perfusion density(VPD), vessel length density(VLD)and fovea avascular zone(FAZ)of superficial capillary plexus(SCP)were evaluated detected by optical coherence tomography(OCT and OCTA)before and 1mo after the third injection. Mf-ERG was used to analyze the amplitude density of P1 wave and latency of P1, N1 wave from ring 1 and ring 2. RESULTS: After treatment, BCVA(LogMAR)was improved significantly compared with that before(0.323±0.086 vs 0.773±0.304, Pvs 489.346±137.453μm, PP>0.05). The latency of P1, N1 wave of ring 1 and ring 2 were significantly decresed from baseline, while the amplitude density of P1 wave was increased(PPCONCLUSION: In patients with BRVO-ME, ranibizumab therapy can reduce CMT, improve BCVA and improve the structure and function of macular area. Age, BCVA before treatment and microstructure parameters of macular area can be used as predictors of vision improvement.

Background Occult macular dystrophy (OMD) is a rare hereditary macular dystrophy characterized by severe bilateral progressive loss of central vision with normal fundus appearance and normal fundus fluorescein angiography. Aim The aim of this study was to assess the correlation between multifocal electroretinogram (mf-ERG) parameters and best-corrected visual acuity (BCVA) in patients with OMD. Patients and methods In all, 20 eyes of 10 patients with OMD and 20 eyes of 10 age-matched and sex-matched normal individuals were included in this study. Full ophthalmic examination, fundus fluorescein angiography, optical coherence tomography, full-field ERG and mf-ERG were performed for all participants. The average amplitude density of P1 wave, amplitude, and implicit time of P1 and N1 waves were recorded in the five concentric hexagonal rings. Correlation between these mf-ERG parameters and BCVA (LogMAR) was analyzed. Results There were no statistically significant differences in age, sex, and refraction between the studied groups (P=0.54, 1.0, and 0.82, respectively). Mf-ERG parameters in OMD patients showed significant central depression with less affection of peripheral rings. The average amplitude density of P1 wave and the amplitude of P1 and N1 waves were significantly reduced in the central rings (rings 1, 2, and 3), with less impairment in paracentral areas (rings 4 and 5). The implicit time of P1 and N1 waves were significantly delayed across the central rings in OMD patients. The BCVA (LogMAR) was significantly negatively correlated with the amplitude of P1 and N1 waves (P≤0.001). The BCVA (LogMAR) was significantly positively correlated with the implicit time of P1 and N1 waves (P≤0.001). Multiple regression analysis demonstrated that the amplitude and latency of P1 and N1 waves in the central rings (1 and 2) were the most important determinants for BCVA. Conclusion Mf-ERG has a key role in the detection of OMD and can be considered as a valuable objective test for the detection of central/macular dysfunction. The amplitude and latency of P1 and N1 waves in rings 1 and 2 may be used as biomarkers for the prediction of visual prognosis in these patients.

Background Retinal vein occlusion (RVO) is one of the most common vascular retinal disorders that lead to macular edema. There is often discrepancy between visual prognosis and optical coherence tomography (OCT) changes. Multifocal electroretinogram (mfERG) provides useful information about retinal function in affected parts of the retina in patients with RVO. Purpose The aim of this study was to assess the functional changes in patients with RVO by mfERG and to correlate these changes with OCT findings in those patients. Patients and methods This is a prospective study of 30 eyes of patients with RVO, with their fellow eyes being taken as control. Thirteen eyes with central RVO, 12 eyes with branch RVO, and five eyes with hemi-RVO were included in the study. OCT to measure the central macular thickness was done in all patients. mfERG was also done in all patients. P wave amplitude and p wave implicit times were measured in the central area and all quadrants. Results mfERG responses were markedly affected in all quadrants in central RVO, in the affected quadrants in branch RVO, and in the affected hemiretina in hemi-RVO. The differences between the p amplitude and p implicit time between the affected eyes and the fellow eyes were statistically significant in all patients. There was a significant correlation between the central macular thickness and p amplitude in the affected half of the retina in hemi-RVO. Conclusion mfERG is a sensitive tool for assessment of retinal function in patients with RVO. mfERG can assess local retinal dysfunction in patients with RVO, which is sensitive to morphological changes detected by OCT.

Background Bardet–Biedl syndrome (BBS) is a very rare autosomal recessive genetic disease with multiple manifestations including the ocular system. Aim This study presents different electrophysiological and clinical findings in three female patients with BBS. Patients and methods 3 female patients (9, 10 and 16 years old) with BBS were complaining of progressive visual loss. Full ophthalmological examination, optical coherence tomography (OCT) and various electrophysiological tests were performed to the 3 cases. Results The fundoscopic findings in all three patients did not show evidence of obvious characteristic signs of retinitis pigmentosa. They presented clinically with atypical form of pigmentary retinal dystrophy. Flash electroretinogram showed severe form of Rod-cone dystrophy in the 3 cases associated with macular dysfunction evident by reduced amplitude and increased implicit time of P1 wave of the multifocal electroretinogram in all rings. The pattern electroretinogram was with poor formed P50 wave. Pattern visual evoked potential showed prolonged latency and reduced amplitude of P100 wave in large and small checks. Conclusion Very reduced flash and multifocal electroretinogram is a Characteristic electrophysiological finding in BBS, which may precede the funduscopic changes, electrophysiological tests may help in the early diagnosis of such cases.

Purpose To correlate the findings of retinal function with multifocal electroretinogram (mfERG), microperimetry (MP), and structural assessments with spectral-domain optical coherence tomography (SD-OCT) in topographically corresponding areas of the macula of patients with birdshot chorioretinopathy (BSCR). Methods Patients diagnosed with BSCR by clinical and imaging findings were included in the study. The mfERG was performed using 61 hexagon stimulus patterns grouped into 5 rings (Diagnosys Inc., USA). Individual responses [N1-P1 amplitudes in nanovolt (NV)/degree2 and P1 implicit time in milliseconds (msec)] for each hexagon in the central 3 rings (R1, 0°–2.3°; R2,2.3°–7.7°; and R3, 7.7°–12°) were obtained (19 hexagons). MP examination consisted of Polar 3–12° test with 28 points in 3 concentric rings with diameters of approximately 2.3°, 6.6°, and 11.1° from the foveal center. SD-OCT was performed using macular scans of 20° × 20°. The retinal sensitivity values on MP and thickness values of retinal layers were correlated with the responses on the mfERG for each topographically correlated hexagon. Results Sixteen eyes of eight patients were included in the study (mean age, 59.87 ± 10.01 years; range, 41–73 years). The amplitudes and the implicit times on mfERG and retinal sensitivities on MP were decreased for each of the 19 hexagons. Considering retinotopically matched points, there was correlation between the retinal sensitivities and mfERG implicit times and response amplitudes in all three rings. The thickness of the retinal pigment epithelium showed modest correlation with the mfERG parameters (ρ = 0.29; p = 0.04). The structural changes on SD-OCT, such as IS-OS disruption, were associated with changes in the mfERG trace arrays. Conclusions The structural and functional assessments in retinae of eyes with BSCR suggest that each imaging tool may be capturing unique aspects of retinal dysfunction. Multimodal imaging may allow detailed analyses of retinal damage at various corresponding loci. These findings are important when considering the use of these techniques in BSCR.

Purpose: To report the efficacy of anti-tumor necrosis factor α (anti-TNFα) on autoimmune-mediated macular cone dysfunction in a Japanese woman with ulcerative colitis (UC). Observations: A 41-year-old woman presented with bilateral visual acuity loss and photophobia. She suffered from UC, and had been treated with prednisolone and 5-aminosalicylate since age 37. Although fundus photographs and optic coherence tomography images were unremarkable, electroretinograms (ERGs) were abnormal. A full-field electroretinogram (full-field ERG) revealed mildly decreased cone responses and oscillatory potential responses bilaterally. Importantly, focal-macular ERG (fmERG) and a multifocal electroretinogram (mfERG) revealed severe macular cone dysfunction in both eyes. Infliximab, a chimeric monoclonal anti-TNFα antibody, was administrated to treat recurrent abdominal symptoms and continued at 8-week intervals. Almost 6 months after infliximab therapy, the mfERG response (especially in the central retina), the fmERG response, and visual acuity recovered bilaterally. Abdominal symptoms also improved after infliximab therapy. Conclusions and importance: Bilateral cone dysfunction with normal fundus were observed in a UC patient, resulting in loss of visual acuity and photophobia. This retinopathy may have been caused by an autoimmune mechanism, such as an autoimmune retinopathy or acute zonal occult outer retinopathy, which is most identifiable by ERG changes. This is the first report demonstrating the efficacy of infliximab in autoimmune retinal dysfunction.

AIM:To use multifocal electroretinogram(MFERG)to evaluate patients' functional changes of the cone system in the macular center of the retina after taking hydroxychloroquine.METHODS:Retrospective study. Totally 264 eyes of 132 patients with rheumatoid arthritis examined in the Ophthalmology Department of the First Medical Center of the PLA General Hospital from January 2017 to November 2019 were included in the analysis. According to the length of medication period, patients were divided into 6 groups: 38 cases 76 eyes in group A did not take hydroxychloroquine, 38 cases 76 eyes in group B took hydroxychloroquine for 1a, 17 cases 34 eyes in group C took hydroxychloroquine for 2a, 18 cases 36 eyes in group D took hydroxychloroquine for 3a, 13 cases 26 eyes in group E took hydroxychloroquine for 5a, and 8 cases 16 eyes in group F took hydroxychloroquine for 5a or more and stopped for 3a. The changes of the best corrected visual acuity(BCVA)and the P1 wave amplitude density value of the first ring retinal response area in the central MFERG were compared among groups.RESULTS:There was no significant difference in BCVA among groups A to F(F=1.287, P=0.270), BCVA in A-F groups were(0.11±0.11, 0.11±0.10, 0.13±0.10, 0.15±0.10, 0.15±0.11, 0.14±0.10 LogMAR),but the amplitude density of P1 wave in group A(122.68±1.87nV/deg2)was significantly higher than other groups(115.76±1.71, 113.38±1.51, 109.10±2.52, 94.61±0.78, 94.02±0.91nV/deg2, all P

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.

Paracentral acute middle maculopathy (PAMM) is an optical coherence tomography (OCT) finding seen in patients with retinal capillary ischemia. In this case report, we present a case of PAMM after a transient central retinal artery occlusion and the multifocal electroretinogram (mfERG) and other multimodal imaging findings. Clinical examination, OCT angiography, OCT en face, fluorescein angiography, and visual fields were performed at the baseline and follow-up examinations. As a result, we identified in this PAMM case evidence of hypoperfusion in both the choriocapillaris as well as the deep capillary plexus. To the best of our knowledge, the involvement of choriocapillaris has not been reported previously in the literature. Moreover, we concluded that mfERG constitutes a useful investigation in PAMM and this is the first mfERG findings to be presented for a PAMM case specifically.

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

AIM: To analyze the efficacy and influencing factors of patients with proliferative diabetic retinopathy(PDR)after vitrectomy.METHODS: Totally 94 patients(112 eyes)with stage VI of PDR in our hospital from January 2015 to January 2018 divided into maculopathy group(n=61 cases, 70 eyes)and non-maculopathy group(n=33 cases, 42 eyes)according to the OCT. The visual acuity, P1 wave amplitude density and retinal reattachment in macular area were compared between the two at 6mo of follow-up. Postoperative efficacy and influencing factors of stage VI of PDR were analyzed by taking vision improvement as a standard of efficacy evaluation.RESULTS: The visual acuity grading in maculopathy group at 6mo after operation was better than that in non-maculopathy group(PPPPCONCLUSION: Vitrectomy can improve postoperative visual acuity of patients with stage VI of PDR, and preoperative combination of significant maculopathy and course of diabetes mellitus are important factors affecting postoperative efficacy in patients with severe PDR.

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

International audience; Purpose: To analyze the temporal trends in structural changes using spectral-domain optical coherence tomography and functional changes using multifocal electroretinogram after rhegmatogenous retinal detachment surgery. Methods: This prospective cohort study enrolled 69 patients with macula-off rhegmatogenous retinal detachment who underwent successful surgery. Early Treatment Diabetic Retinopathy Study visual acuity, multifocal electroretinogram evaluation of the central 5 degrees, and spectral-domain optical coherence tomography were recorded at 1, 3, 6, and 12 months (M) after surgery. The fellow eye served as the control group for multifocal electroretinogram parameters. Results: Between M1 and M12, visual acuity improved from 64 to 75 letters (P = 0.001) and implicit time of N1 decreased from 27.8 to 25.2 milliseconds (P = 0.001), whereas the other parameters did not vary significantly. Amplitude and implicit time values did not reach normal values at M12. Alterations of the ellipsoid zone and the external limiting membrane decreased over time (P = 0.001). P1 implicit time correlated independently with the alteration of the external limiting membrane (P = 0.007). Conclusion: Foveal wave amplitudes remain lower than normal values after successful surgery of rhegmatogenous retinal detachment, whereas anatomical improvement was found for outer retinal abnormalities and subretinal edema fluid. Retinal recovery improves N1 implicit time over time. Disruption of external limiting membrane seems to be predictive of increased P1 implicit time.

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.

The multifocal electroretinogram (mfERG) is an electrophysiological test that allows the function of multiple discrete areas of the retina to be tested simultaneously. This document, from the International Society for Clinical Electrophysiology of Vision (ISCEV), presents an updated and revised ISCEV standard for clinical mfERG and defines minimum protocols for basic clinical mfERG recording and reporting so that responses can be recognized and compared from different laboratories worldwide. The major changes compared with the previous mfERG standard relate to the minimum length of m-sequences used for recording, reporting of results and a change in document format, to be more consistent with other ISCEV standards.

The involvement of macular preganglionic elements&rsquo, function, during the neurodegenerative process of multiple sclerosis (MS), is controversial. In this case-control observational and retrospective study, we assessed multifocal electroretinogram (mfERG) responses from 41 healthy Controls, 41 relapsing-remitting MS patients without optic neuritis (ON) (MS-noON Group) and 47 MS patients with ON: 27 with full recovery of high-contrast best corrected visual acuity (BCVA) (MS-ON-G Group) and 20 with poor recovery (between 0.2 and 1 LogMAR) of BCVA, (MS-ON-P Group). In the latter Group, Sd-OCT macular volumes and thicknesses of whole and inner and outer retina were measured. 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&ndash, 5&deg, (R1), 5&ndash, 10&deg, (R2), 10&ndash, 15&deg, (R3), 15&ndash, 20&deg, (R4), 20&ndash, 25&deg, (R5), and from retinal sectors (superior, nasal, inferior and temporal) between 0&ndash, and 0&ndash, In the MS-ON-P Group, mean mfERG RADs detected from R1 (0&ndash, ) and from the central nasal sector (0&ndash, ) were significantly reduced (p &lt, 0.01) with respect to those of the Control, MS-noON and MS-ON-G Groups. No other significant differences between Groups for any mfERG parameters were found. All Sd-OCT measurements, apart from the inner retina macular volume in the central 1 mm, were significantly reduced in MS-ON-P patients compared to Controls. The functional impairment in the MS-ON-P Group was associated but not correlated with structural changes of the outer and inner retinal layers in corresponding retinal Areas and Sectors. Our results suggest that in MS, exclusively after ON with poor recovery of BCVA, the neurodegenerative process can induce dysfunctional mechanisms involving photoreceptors and bipolar cells of the fovea and of the more central nasal macular area.

Purpose To report the case of a ten-year old girl with torpedo maculopathy with a complete vitelliform lesion and describe associated optical coherence tomography (OCT), OCT angiography (OCTA), multifocal electroretinogram (ERG) and adaptive optics ophthalmoscopy (AOO) imaging of the lesion. Observations An asymptomatic ten-year old girl with visual acuity of 20/15 OU was referred for evaluation of possible Best's disease of her left eye. The unilaterality, location, and shape of the lesion was consistent with torpedo maculopathy. OCT and autofluorescence (AF) revealed that the entire lesion was composed of subretinal hyperreflective material that was hyperautofluorescent, consistent with vitelliform material. Within the boundary of the lesion, OCTA showed reduced choriocapillaris density while adjacent to the lesion, the choriocapillaris density was slightly increased. Microperimetry demonstrated normal sensitivity in both eyes, electrooculograms (EOG) were normal and multifocal ERG showed symmetrical mildly supernormal amplitudes. Additionally, AOO demonstrated that nasal to the lesion there were clusters of hyper-reflective areas, and immediately adjacent to the lesion cones were poorly resolved. However, there was a return to more normal photoreceptor architecture outside of the lesion. Conclusions and Importance Torpedo maculopathy lesions typically present with outer retinal attenuation and retinal pigmented epithelium (RPE) atrophy. Vitelliform material was recently observed for the first time in association with Torpedo maculopathy in a case report that described small vitelliform material at the periphery of the lesion. We report the second case of torpedo maculopathy associated with a vitelliform lesion and the first description of a torpedo lesion composed fully of presumed vitelliform material. We also describe findings of OCTA, multifocal ERG and AOO imaging in torpedo maculopathy with vitelliform lesion.

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.

Frontiers in Neurology, 11, ISSN:1664-2295

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

As multiple sclerosis (MS) usually affects the visual pathway, visual electrophysiological tests can be used to diagnose it. The objective of this paper is to research methods for processing multifocal electroretinogram (mfERG) recordings to improve the capacity to diagnose MS. MfERG recordings from 15 early-stage MS patients without a history of optic neuritis and from 6 control subjects were examined. A normative database was built from the control subject signals. The mfERG recordings were filtered using empirical mode decomposition (EMD). The correlation with the signals in a normative database was used as the classification feature. Using EMD-based filtering and performance correlation, the mean area under the curve (AUC) value was 0.90. The greatest discriminant capacity was obtained in ring 4 and in the inferior nasal quadrant (AUC values of 0.96 and 0.94, respectively). Our results suggest that the combination of filtering mfERG recordings using EMD and calculating the correlation with a normative database would make mfERG waveform analysis applicable to assessment of multiple sclerosis in early-stage patients.

Paulo Rodolfo Tagliari Barbisan,1 Marina Gonçalves Monteiro Viturino,1 Fernanda Maria Silveira Souto,1 Bo Tian,2,3 Roberto Damian Pacheco Pinto,1 Lucas Barasnevicius Quagliato,1 Maurício Abujamra Nascimento,1 Rosane Silvestre de Castro,1 Carlos Eduardo Leite Arieta1 1Department of Ophthalmology, State University of Campinas, Campinas, São Paulo, Brazil; 2Angiogenesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA; 3Department of Ophthalmology and Visual Sciences, University of Massachusetts Medical School, Worcester, MA, USA Purpose: To assess potential vascular, structural, and functional changes to the macula in patients with keratoconus that underwent ultraviolet A (UVA)–riboflavin-mediated corneal collagen cross-linking (CXL) therapy.Patients and methods: Seventeen eyes from 17 patients of age 16 years or older with keratoconus undergoing CXL treatment were studied. The same eye served as its own control (before CXL vs after CXL). Eyes were evaluated in terms of best-corrected visual acuity (BCVA), refractive error, intraocular pressure, Amsler grid, retinography, fluorescein angiography, autofluorescence, and spectral domain optical coherence tomography (SD-OCT) prior to CXL and 7 and 30 days after treatment. Multifocal electroretinography (mfERG) was recorded prior to and 7 days after CXL.Results: Mean (SD) BCVA by logMAR chart was 0.47 (±0.12) pre-CXL, 0.55 (±0.15) 7 days post-CXL (P=0.57), and 0.46 (±0.10) 30 days post-CXL (P=0.87). Mean (SD) SD-OCT central macular thickness (µm) was 253.62 (±20.9) pre-CXL, 260.5 (±18.7) 7 days post-CXL (P=0.48), and 256.44 (±21.6) 30 days post-CXL (P=0.69). In 12 eyes, mfERG revealed a statistically significant increase (P=0.0353) in P1 latency (ms) of ring four from the pre-CXL period (39.45±2.05) to 7 days post-CXL (41.04±1.28) period. Regression analysis showed that the increase in P1 latency was correlated with the increase in central macular thickness (P=0.027). Furthermore, nine patients experienced a significant decrease in P1 amplitudes of rings 1 (P=0.0014), 2 (P=0.0029), 3 (P=0.0037), 4 (P=0.0014), and 5 (P=0.0012) from pre-CXL to 7 days post-CXL.Conclusion: In this pilot study, most of the patients exhibited slight changes in their mfERG parameters and OCT thickness, despite a lack of vascular abnormalities observed on fluorescein angiography/autofluorescence imaging, no alteration in BCVA, and no reports of symptoms. These changes could, therefore, be categorized as a mild subclinical effect of the corneal cross-linking procedure. Keywords: keratoconus, light damage, multifocal electroretinogram, UVA, phototoxicity, crosslinking

AIM:To evaluate the efficacy of anti- vascular endothelial growth factor(VEGF)and photodynamic therapy(PDT)on pathological myopia(PM)combined with choroidal neovascularization(CNV)using ETDRS chart and multifocal electroretinogram(mfERG). METHODS: Forty-three patients(45 eyes)diagnosed by fundus fluorescein angiography(FFA), indocyanine green angiograph(ICGA)and optical coherence tomography(OCT)with PM combined with macular CNV were recruited in this study. The patients were randomly divided into two groups for different treatments, intravitreal injection with Ranibizumab(20 patients, 22 eyes)and PDT(23 patients, 23 eyes). After treatment, all patients had been followed up monthly for 12mo. The further treatments were operated according to referral situations. The best corrected visual acuity(BCVA)was recorded with the ETDRS chart and mfERG. At the last follow-up, the therapy efficacy was determined by ETDRS numbers and mfERG and analyzed. RESULTS:Before treatment, there was no significant difference on the baseline in ETDRS and mfERG latency of N1 wave, latency and the density values of P1 wave between ranibizumab group and PDT group. After 12mo treatment, the ETDRS number in ranibizumab group(39.23±20.06)significantly increased to the baseline by 5.88±9.03(PP>0.05). There was no significant difference in latency of N1 wave, latency and the density values of P1 wave from treatment response of mfERG in the two groups(P>0.05). CONCLUSION: In the treatment of macular CNV complicated by the PM, ranibizumab injection can improve visual function better than PDT, while similar on macular.

As the increasing population aging, the incidence of age-related macular degeneration is increasing, blinding rate also increasing, so it is very important for the early diagnosis and treatment of age-related macular degeneration. There are many methods to check the aging macular degeneration, such as fundus angiography, optical coherence tomography(OCT), visual field and multifocal electroretinogram(mfERG). In recent years, many emerging ophthalmic methods have emerged and are gradually applied to clinical diagnosis, including optic coherence tomography angiography(OCTA). The function of these methods has its unique advantages, but there are also limitations. This paper will review these existing methods.

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.

Aim To evaluate the role of bone marrow-derived stem cells in the treatment of advanced dry age-related macular degeneration (AMD) using multifocal electroretinogram (mf-ERG) and fundus autofluorescence imaging. Methods Thirty patients (60 eyes) with bilateral central geographic atrophy (GA) were recruited. Worse eye of each patient received autologous bone marrow-derived hematopoietic stem cells (BM-HSCs) (group 1) and the fellow eye with better visual acuity served as control (group 2). The effect of stem cell therapy was determined in terms of visual acuity, amplitude and implicit time in mf-ERG and size of GA on fundus autofluorescence imaging. These tests were performed at presentation and first, third and sixth month follow up. Adverse events (if any) were also monitored. Results At 6mo follow-up there was no statistically significant improvement in median logMAR best corrected visual acuity (BCVA) in either group. Mf-ERG revealed significant improvement in amplitude and implicit time in the intervention group. A significant decrease was also noted in greatest linear dimension (GLD) of GA in the eyes receiving stem cells [6.78±2.60 mm at baseline to 6.56±2.59 mm at 6mo (P=0.021)]. However, no such improvement was noted in the control group. Conclusion Electrophysiological and anatomical improvement in the intervention group sheds light on the therapeutic role of BM-HSCs. Further studies are required to determine the stage of disease at which the maximal benefit can be achieved and to standardize the dose and frequency of stem cell injection.

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

AIM: To study the effect of intravitreal injection of anti- vascular endothelial growth factor(VEGF)on best corrected visual acuity(BCVA)and multifocal-electroretinogram(mfERG)before and after treatment for choroidal neovascular disease.METHODS: A total of 264 patients(332 eyes)with macular neovascularization(MCNV)and idiopathic choroidal neovascular disease(ICNV)who underwent pathologic myopia from January 2015 to January 2017 were enrolled in this study. Intraocular pressure and BCVA, fundus using 90D front mirror and slit lamp detection, and the fundus photograph, OCT, ICGA and FFA angiography, mfERG detection were taken. One month after the drug, 1mo after the final treatment, we recorded BCVA, intraocular pressure and mfERG and so on. RESULTS: Ranibizumab was injected into the 254 eyes, and 78 eyes were injected with conbercept. There were 37 eyes injected once, 147 eyes were injected twice, 72 eyes were injected 3 times, 57 eyes were injected 4 times, 19 eyes 5 times. There were no significant differences on intraocular pressure between the two groups(P>0.05). The BCVA before treatment was significantly different compared with those 1mo after treatment and 1mo after the final treatment(P>0.05). The amplitude of Ring1, Ring2 and Ring4 increased after treatment, the difference was statistically significant.(PPCONCLUSION:Intravitreal injection of anti-VEGF drugs has a significant effect on BCVA and mf ERG in patients with choroidal neovascular disease and is safe.

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

BACKGROUND: The aim of this study was to evaluate responses on multifocal electroretinogram (mfERG) with ganglion cell-inner plexiform layer (GCIPL) thickness on cirrus spectral-domain optical coherence tomography (SD-OCT) in glaucoma. METHODS: All diagnosed glaucoma patients attending glaucoma services at our institute from November 2012 to April 2013 were screened for this observational hospital-based study. Controls included patients attending our outpatient services for general eye checkup. Structural parameters on SD-OCT including GCIPL and retinal nerve fiber layer (RNFL) thickness were compared with functional parameters on mfERG in early (mean deviation

AIM: To investigate the efficacy of anti-vascular endothelial growth factor(VEGF)drugs in the treatment of choroidal neovascularization(CNV)and its effects on intraocular pressure, best corrected visual acuity(BCVA)and multifocal electroretinogram(mfERG). METHODS:Totally 44 cases(44 eyes)of idiopathic CNV patients treated in our hospital from February 2015 to January 2017 were selected. All patients were treated with intravitreal injection of anti-VEGF. BCVA, intraocular pressure, mfERG and central retinal thickness(CRT)were observed after treatment. RESULTS: At 1 and 3mo after treatment, BCVA and CRT were significantly improved than those before treatment(PPP>0.05). At 1 and 3mo after treatment, amplitudes of Ring1, Ring2 and Ring4 NI-P1 were higher than those before treatment(PPPP>0.05). CONCLUSION: Anti-VEGF drugs are effective in the treatment of idiopathic CNV, which can improve vision and macular retinal function, decrease the retinal thickness, and do not affect the intraocular pressure.

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.

Aim To evaluate the effect of prophylactic administration of nepafenac in prevention of macular edema occurring in diabetic patients after phacoemulsification and to investigate the correlation between optical coherence tomography (OCT) foveal thickness and multifocal electroretinogram (MF-ERG) parameters. Methods The study included two groups. Group 1 included 50 diabetic patients with senile cataract (50 eyes, 30 females, 20 males, aged 55±7y) received nepafenac 0.1% eye drop. Group 2 included another 50 diabetic patients with senile cataract (50 eyes, 22 female, 28 males, aged 53.8±8y) did not receive nepafenac. All patients were followed up for 3mo postoperatively. OCT and MF-ERG were done preoperative and at 1wk, 1, 2 and 3mo. Results The mean foveal thickness was statistically significantly lower in Group 1. Five eyes in Group 2 developed clinical cystoid macular oedema (CMO) (10%), and no patients in Group 1 developed central macular thickening more than 50 µm. There were insignificant differences in MF-ERG amplitudes and latencies between the two groups except in the five eyes that developed CMO, there statistically significant reduction of MF-ERG amplitude with increase in foveal thickness. Conclusion Perioperative nepafenac reduces the incidence of CMO following uncomplicated phacoemulsification significantly. Nepafenac has no side effects.

INTRODUCTION[|]To evaluate the relationships between macular choroidal thickness (mCT) and ocular parameters, such as optic nerve head (ONH) and multifocal electroretinogram (mf-ERG) parameters, in cases with primary open-angle glaucoma (POAG).[¤]METHODS[|]This controlled and prospective clinical trial included 49 patients with POAG diagnosed for the fırst time and 47 healthy participants. Macular CTs, ONH and mf-ERG parameters were measured, and the examination findings were recorded at baseline and follow-ups.[¤]RESULTS[|]In the POAG group, the mean mCT was 254.92+-37.65 μm at baseline, and it was 235.6+-38.48 μm at 3-month and was 237.55+-37.27 μm at 6-month. In the glaucoma group, there was a significant decrease in the first three months despite the treatment, but no significant change was observed in the next three months. In the healthy group, the mean mCTs were 287.78+-26.77 μm, 285.48+-25.58 μm and 285.02+-27.44 μm at baseline, at 3-month and at 6-month, respectively. No significant change was observed in the control group throughout the process. However, the mean mCT values in the glaucoma group were significantly thinner in all controls compared to the healthy group (p

AIM: To assess the visual function prognosis after vitrectomy for patients with proliferative diabetic retinopathy(PDR)at stage Ⅵ and the impacting factors and to evaluate visual function using multifocal electroretinogram(mfERG). METHODS: One hundred and thirteen cases(130 eyes)with PDR at stage VI treated with standard vitreoretinal surgery were retrospectively analyzed. According to the OCT examination before surgeries and ocular fundus during surgeries, the reviewed cases were divided into two groups: patients with traction retinal detachment and maculopathy(99 cases with 113 eyes)and without maculopathy(14 cases with 17 eyes). Eyes underwent OCT and mfERG examination. Visual acuity preoperative and postoperative, mfERGP1 wave amplitudes, morphology features of macular,complications and prognoses were analyzed. RESULTS: The rate of improved visual acuity postoperatively was 63.1%(82/130). The vision was 0.05 or better in 19 eyes(14.6%)preoperatively, and in 61 eyes(46.9%)postoperatively, in which the vision of 56 eyes were >0.1. In patients without maculopathy, the rate of visual improvements were 88.2% and there were 94.1% with the vision >0.1, which were both better than patients with significant maculopathy group(59.3% and 35.4%), and the differences were significant(PPPCONCLUSION: The visual function of eyes with PDR at stage VI is improved after vitrectomy. The amplitude densities of P1 wave in the 6 rings increase markedly after vitrectomy, and they turn to be better with time. The improvement of visual function in severe PDR without maculopathy group is better than that in severe PDR with maculopathy group after vitrectomy.

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 assess preganglionic retinal function using multifocal electroretinogram (mfERG) in patients affected by dominant optic atrophy (DOA) stratified by OPA1 gene mutation. Methods: Multifocal electroretinogram (mfERG) was recorded in 18 DOA patients (DOA group, 35 eyes) and 25 age-matched healthy subjects (control group, 25 eyes). Patients were stratified in two groups based on gene mutation: missense mutation (DOA-M group, 11 eyes) and mutation causing haploinsufficiency (DOA-H group, 24 eyes). The mfERG N1-P1 response amplitude density (RAD) has been evaluated in five annular retinal areas with different eccentricity from the fovea (ring 1: 0–5 degrees, R1; ring 2: 5–10 degrees, R2; ring 3: 10–15 degrees, R3; ring 4: 15–20 degrees, R4; and ring 5: 20–25 degrees, R5) and in eight sectors on the basis of the retinal topography: temporal–superior (TS), temporal–inferior (TI), nasal–superior (NS) and nasal–inferior (NI), temporal (T), superior (S), nasal (N) and inferior (I). Results: Compared to controls, DOA group revealed a significant reduction in N1-P1 RADs values in R1-R4 rings and in TI, NS and N sectors [analysis of variance (ANOVA), pÂ

Electrophysiological tests may be used to detect early glaucomatous changes and glaucoma progression risk and to monitor treatment efficacy. Most important pathogenic aspects of glaucomatous process, pathogenesis and multifactorial nature of glaucomatous optic neuropathy are described. Major triggers of glaucomatous optic neuropathy are mechanical and vascular. Principles of neuroprotective therapy, neuroprotective drugs, and mechanisms of action of direct and indirect neuroprotective agents are presented. IOPcc is a basis for neuroprotective therapy selection and its efficacy monitoring. Amongst neuroprotective drugs, NMDA agonists, antioxidants, peptides, and calcium channel blockers are of special importance. Structural damage and functional deficiency (e.g., visual field loss) in glaucoma and the most informative and accurate methods of their detection are characterized. Confocal laser microscopy, optical coherence tomography, and scanning laser polarimetry are compared. These techniques are used to study optic nerve head and retinal nerve fiber layer. They are proposed as diagnostic and monitoring tools for glaucoma, glaucoma suspicion, and ocular hypertension. The most sensitive and specific electrophysiological tests for glaucomatous optic neuropathy are pattern electroretinography, multfocal electroretinography, and multifocal visually evoked potentials.

PURPOSE. The purpose of this study was to assess thinning of the peripapillary retinal nerve fiber layer (RNFL) in prediabetes or type 2 diabetes without diabetic retinopathy (DM2 w/o DRP) compared with that in individuals with normal glucose metabolism (NGM).METHODS. We measured sectoral and mean RNFL thickness in a 3.45-mm-diameter circular scan centered on the optic nerve head, using spectral domain optical coherence tomography in 1172 participants from The Maastricht Study (a population-based cohort of individuals 59 6 8 years of age, 47% men, 699 NGM, 186 with prediabetes, and 287 with DM2 w/o DRP). Multivariate linear regression was used to assess the association between RNFL thickness and glucose metabolism status, adjusted for age and sex.RESULTS. In individuals with prediabetes, the temporal RNFL was thinner than that in individuals with NGM after adjustment (beta = -2.28 mu m [95% confidence interval [CI], -4.44 to -0.13], P = 0.04), whereas in individuals with DM2 w/o DRP, the temporal inferior (beta = -3.66 mu m [95% CI, -6.46 to -0.85], P = 0.01), the temporal superior (beta = -2.99 mu m [95% CI, -5.95 to -0.02], P = 0.05), the temporal (beta = -2.73 mu m [95% CI, -4.62 to -0.84], P CONCLUSIONS. Temporal RNFL thinning is already present in individuals with prediabetes. More widespread RNFL thinning occurs in individuals with DM2 w/o DRP, that is before vascular changes are detected. This suggests preferential retinal nerve fiber layer loss in areas related to the papillomacular bundle.

Dear Editor, We read with a great interest the article entitled “successful use of intravitreal and systemic colistin in treating multidrug resistant Pseudomonas aeruginosa postoperative endophthalmitis” by Samant and Ramugade.[1] They explored the efficacy of intravitreal and intravenous colistin in postoperative endophthalmitis; however, there are some points to be cleared out. First, the dose of intravitreal dexamethasone in the study was 10-fold greater than the recommended dose regimen. Second, there are no safety studies of colistin when given intravitreally; therefore, there is no determined safe intravitreal dose of colistin. Third, it has been reported that colistin did not reach therapeutically relevant levels in the aqueous and in the vitreous humor of rabbit eyes.[2] We wonder why the authors used such a high concentration of dexamethasone. The intravitreal dexamethasone dose should be 0.4 mg/0.1 ml instead of 4 mg/0.1 ml.[3] It would be informative if the authors explained how they found the dose of intravitreal colistin as 0.1 mg/0.1 ml. Finally, we argue that there should be a limited role for intravenously administered colistin in the treatment of Gram-negative bacterial endophthalmitis.

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.