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Abstract Objective To study the changes of retinal function in type 2 diabetes mellitus(DM) patients without apparently diabetic retinopathy via multifocal electroretinogram. Methods: Thirty-six type 2 DM patients (72 eyes) without visible diabetic retinopathy were selected as the experimental group, and thirty-five healthy subjects (70 eyes) were selected as the control group. All subjects were underwent multifocal electroretinogram (mf- ERG). Results Compared with the control group, the implicit time delay of the P1 wave in the first ring, third ring, fourth ring, and fifth ring of the experimental group was significant (t = -3.154, p = 0.004, t = -8.21, p = 0.000, t = -3.067, p = 0.004, t = -4.443, p = 0.000, respectively). The implicit time of the N1 wave in the fourth- and fifth-ring were also significantly delayed compared with the control group (t = -3.549, p = 0.001, t = 2.961, p = 0.005, respectively). Compared with the control group, the implicit time of the P1 wave and N1 wave in the temporal region of the experimental group were delayed (t = -2.148, p = 0.037, t = -2.834, p = 0.007, respectively). There were no significant difference between the experimental group and the control group of the temporal area in the amplitude density of P1 wave, N1 wave. There was no difference in the implicit time and amplitude density of the N1 and P1 waves in the nasal region between the experimental group and the control group. The multifocal electroretinogram complex parameters showed better specificity and sensitivity in the diagnosis of diabetic retinopathy. Conclusion The multifocal electroretinogram can detect abnormal changes in the retina of type 2 DM patients without visible diabetic retinopathy. The multifocal electroretinogram complex parameter is a potential indicator for the early diagnosis of diabetic retinopathy.

Abstract Background To determine the efficacy and safety of intravitreally injected conbercept, a vascular endothelial growth factor receptor fusion protein, for the treatment of idiopathic choroidal neovascularization (ICNV). Methods This retrospective study analyzed outcomes in 40 patients (40 eyes) with ICNV who received intravitreal injections of conbercept 0.5 mg (0.05 ml) and were followed up for at least 12 months. All patients underwent full ophthalmic examinations, including best-corrected vision acuity (BCVA), intraocular pressure (IOP), slit-lamp examination, color fundus photography, optical coherence tomography angiography, multifocal electroretinogram, and fundus fluorescence angiography, if necessary, at baseline and after 1, 3, 6, and 12 months. BCVA, macular central retinal thickness (CRT), IOP, CNV blood flow area, thickness of the CNV-pigment epithelial detachment complex, thickness of the retinal nerve fiber layer (RNFL), and the first positive peak (P1) amplitude density in ring 1 before and after treatment were compared. Results Mean baseline BCVA (logMAR), CRT, CNV blood flow area, and CNV-pigment epithelial detachment complex thickness were significantly lower 1, 3, 6, and 12 months after than before conbercept treatment (P

Background: To determine the efficacy and safety of intravitreally injected conbercept, a vascular endothelial growth factor receptor fusion protein, for the treatment of idiopathic choroidal neovascularization (ICNV). Methods: This retrospective study analyzed outcomes in 40 patients (40 eyes) with ICNV who received intravitreal injections of conbercept 0.5 mg (0.05 ml) and were followed up for at least 12 months. All patients underwent full ophthalmic examinations, including best-corrected vision acuity (BCVA), intraocular pressure (IOP), slit-lamp examination, color fundus photography, optical coherence tomography angiography, multifocal electroretinogram, and fundus fluorescence angiography, if necessary, at baseline and after 1, 3, 6, and 12 months. BCVA, macular central retinal thickness (CRT), IOP, CNV blood flow area, thickness of the CNV-pigment epithelial detachment complex, thickness of the retinal nerve fiber layer (RNFL), and the first positive peak (P1) amplitude density in ring 1 before and after treatment were compared. Results: Mean baseline BCVA (logMAR), CRT, CNV blood flow area, and CNV-pigment epithelial detachment complex thickness were significantly lower 1, 3, 6, and 12 months after than before conbercept treatment (P < 0.05 each). IOP and baseline RNFL thickness were unaffected by conbercept treatment. P1 amplitude density was significantly higher 1, 3, 6, and 12 months after than before conbercept treatment (P < 0.05 each). None of the 40 eyes showed obvious ocular adverse reactions, such as endophthalmitis, glaucoma, cataract progression, and retinal detachment, and none of the patients experienced systemic adverse events, such as cardiovascular and cerebrovascular accidents. Conclusions: Intravitreal injection of conbercept is beneficial to eyes with ICNV, inducing the recovery of macular structure and function and improving BCVA, while not damaging the neuroretina. Intravitreal conbercept is safe and effective for the treatment of ICNV. [ABSTRACT FROM AUTHOR]

Objective: To study the changes of retinal function in type 2 diabetes mellitus(DM) patients without apparently diabetic retinopathy via multifocal electroretinogram. Methods: Thirty-six type 2 DM patients (72 eyes) without visible diabetic retinopathy were selected as the experimental group, and thirty-five healthy subjects (70 eyes) were selected as the control group. All subjects were underwent multifocal electroretinogram (mf- ERG). Results: Compared with the control group, the implicit time delay of the P1 wave in the first ring, third ring, fourth ring, and fifth ring of the experimental group was significant (t = -3.154, p = 0.004, t = -8.21, p = 0.000, t = -3.067, p = 0.004, t = -4.443, p = 0.000, respectively). The implicit time of the N1 wave in the fourth- and fifth-ring were also significantly delayed compared with the control group (t = -3.549, p = 0.001, t = 2.961, p = 0.005, respectively). Compared with the control group, the implicit time of the P1 wave and N1 wave in the temporal region of the experimental group were delayed (t = -2.148, p = 0.037, t = -2.834, p = 0.007, respectively). There were no significant difference between the experimental group and the control group of the temporal area in the amplitude density of P1 wave, N1 wave. There was no difference in the implicit time and amplitude density of the N1 and P1 waves in the nasal region between the experimental group and the control group. The multifocal electroretinogram complex parameters showed better specificity and sensitivity in the diagnosis of diabetic retinopathy. Conclusion: The multifocal electroretinogram can detect abnormal changes in the retina of type 2 DM patients without visible diabetic retinopathy. The multifocal electroretinogram complex parameter is a potential indicator for the early diagnosis of diabetic retinopathy. [ABSTRACT FROM AUTHOR]

Variation of multifocal electroretinogram (mfERG) data presentation in existing scientific publications is a challenge for eye care practitioners to apply the scientific information for evidence-based practice in patient management. This review offers an overview of the mfERG data presentation types. Eight types of data presentation in the form of a table, scatter plot, line graph, bar graph/box plot, single waveform/a group of waveforms, trace array topography, three-dimensional topography, and two-dimensional topography are identified. The table format is used to provide the exact values. Line graphs, scatter, and box plots offer information about the relationship of mfERG values. Waveforms are helpful for comparison between groups or conditions. Topographies outline the retinal, especially the specific localized retinal abnormalities. An infographic of fundamental mfERG electrical response with definitions and clinical indications is provided to bridge the gap between researchers and clinicians to facilitate efficient clinical application.

AIM:To observe the changes of photopic negative response(PhNR)of multifocal electroretinogram(mf-ERG)in patients with diabetic macular edema(DME)before and after treatment with Aflibercept.METHODS: A total of 37 patients(37 eyes)with DME who visited the Aier Eye Hospital of Wuhan University(Wuhan Aier Eye Hospital)from May 2019 to June 2022, and 0.05 mL of aflibercept was injected per month for consecutive 3mo were included in this retrospective cohort study. Another 20 cases(20 eyes)with normal physical examination to exclude related eye diseases were selected as the control group. The PhNR amplitude of mf-ERG, best-corrected visual acuity(BCVA; LogMAR), central retinal thickness(CRT), capillary plexus in macular area and vessel density(CPVD)of the participants between the two groups were compared before and after treatment.RESULTS: The PhNR amplitude of mf-ERG in DME patients before treatment(201.69±80.92nV)was significantly lower than that in the normal control group(398.87±77.92nV; P

Variation of multifocal electroretinogram (mfERG) data presentation in existing scientific publications is a challenge for eye care practitioners to apply the scientific information for evidence-based practice in patient management. This review offers an overview of the mfERG data presentation types. Eight types of data presentation in the form of a table, scatter plot, line graph, bar graph/box plot, single waveform/a group of waveforms, trace array topography, three-dimensional topography, and two-dimensional topography are identified. The table format is used to provide the exact values. Line graphs, scatter, and box plots offer information about the relationship of mfERG values. Waveforms are helpful for comparison between groups or conditions. Topographies outline the retinal, especially the specific localized retinal abnormalities. An infographic of fundamental mfERG electrical response with definitions and clinical indications is provided to bridge the gap between researchers and clinicians to facilitate efficient clinical application. [ABSTRACT FROM AUTHOR]

Background: Hydroxychloroquine (HCQ) is frequently prescribed for managing rheumatic diseases such as systemic lupus erythematosus and rheumatoid arthritis. However, prolonged use of HCQ has been linked to retinal toxicity. Objective: To assess retinal changes in patients receiving HCQ treatment using multifocal electroretinogram (mfERG). Methods: This cross-sectional study included forty Egyptian patients with a history of one year or more of HCQ intake for conditions like systemic lupus erythematosus or rheumatoid arthritis. Patients underwent complete ophthalmic examinations and were subsequently evaluated using multifocal electroretinogram. Results: There was no statistically significant difference in multifocal ERG abnormalities concerning the age distribution among the studied patients (P>0.05). However, a statistically significant difference was observed between mfERG abnormalities and the duration of HCQ treatment (P<0.05). Notably, patients with paracentral depression had the longest treatment duration. Conclusions: The study findings indicate that multifocal ERG serves as a valuable screening tool for early detection of HCQ retinopathy, detecting signal depression, primarily in the paracentral region, in patients treated with HCQ for over 5 years. Importantly, even visually asymptomatic patients with no fundus abnormalities may exhibit abnormal results on mfERG. [ABSTRACT FROM AUTHOR]

Age-related macular degeneration (AMD) is a leading cause of blindness worldwide. In late-stage AMD, geographic atrophy (GA) of dry AMD or choroidal neovascularization (CNV) of neovascular AMD eventually results in macular atrophy (MA), leading to significant visual loss. Despite the development of innovative therapies, there are currently no established effective treatments for MA. As a result, early detection of MA is critical in identifying later central macular involvement throughout time. Accurate and early diagnosis is achieved through a combination of clinical examination and imaging techniques. Our review of the literature depicts advances in retinal imaging to identify biomarkers of progression and risk factors for late AMD. Imaging methods like fundus photography; dye-based angiography; fundus autofluorescence (FAF); near-infrared reflectance (NIR); optical coherence tomography (OCT); and optical coherence tomography angiography (OCTA) can be used to detect and monitor the progression of retinal atrophy. These evolving diverse imaging modalities optimize detection of pathologic anatomy and measurement of visual function; they may also contribute to the understanding of underlying mechanistic pathways, particularly the underlying MA changes in late AMD. [ABSTRACT FROM AUTHOR]

We investigated the potential correlation between morphological and functional parameters describing the rarefaction and dysfunction of retinal ganglion cells (RGCs), located in the macula, in multiple sclerosis eyes with a history of optic neuritis (MS-ON). A total of 19 MS-ON eyes from 19 MS patients (mean age: 44.16 ± 4.66 years; 11 females and 8 males), with a mean disease duration of 10.06 ± 6.12 years and full recovery of visual acuity, and 30 age-similar (mean age: 45.09 ± 5.08 years) healthy eyes were submitted for ophthalmological evaluation using swept-source optical coherence tomography (SS-OCT) and multifocal photopic negative response (mfPhNR) to study the structural and functional features of localized RGCs. Both GCL+ thickness (via SS-OCT) and response amplitude density (RAD) (via mfPhNR) measurements were obtained from annular regions and ETDRS sectors. Morphological and electrophysiological data from the control and MS groups were compared by using an ANOVA test. GCL+ values were correlated with the corresponding RADs derived from almost superimposable areas using Pearson's tests (p < 0.01). In MS-ON eyes, the mean values of macular GCL+-T and mfPhNR RAD detected in all rings and ETDRS sectors were significantly reduced (p < 0.01) when compared with control ones. In addition, when plotting the GCL+-T and mfPhNR RAD individual data from MS-ON eyes, we found statistically significant linear correlations (p < 0.01) when considering responses from both rings and sectors. In conclusion, in MS-ON eyes, a topographical correlation between structural and functional impairment of macular RGCs occurs. [ABSTRACT FROM AUTHOR]

Inherited retinal dystrophies encompass a diverse group of disorders affecting the structure and function of the retina, leading to progressive visual impairment and, in severe cases, blindness. Electrophysiology testing has emerged as a valuable tool in assessing and diagnosing those conditions, offering insights into the function of different parts of the visual pathway from retina to visual cortex and aiding in disease classification. This review provides an overview of the application of electrophysiology testing in the non-macular inherited retinal dystrophies focusing on both common and rare variants, including retinitis pigmentosa, progressive cone and cone-rod dystrophy, bradyopsia, Bietti crystalline dystrophy, late-onset retinal degeneration, and fundus albipunctatus. The different applications and limitations of electrophysiology techniques, including multifocal electroretinogram (mfERG), full-field ERG (ffERG), electrooculogram (EOG), pattern electroretinogram (PERG), and visual evoked potential (VEP), in the diagnosis and management of these distinctive phenotypes are discussed. The potential for electrophysiology testing to allow for further understanding of these diseases and the possibility of using these tests for early detection, prognosis prediction, and therapeutic monitoring in the future is reviewed. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies have demonstrated functional and structural retinal changes in type 2 diabetes (T2DM). However, less is understood in prediabetes, which is an important precursor to T2DM. Here, we evaluate the microvasculature structure of the foveal avascular zone (FAZ) and how it is correlated with retinal function as measured by the multifocal electroretinogram (mfERG) across levels of glucose dysfunction to uncover how T2DM and prediabetes alter this structure–function relationship. Methods: 33 subjects were included: 9 controls, 12 prediabetes, 12 T2DM with no retinopathy or edema. Subjects were aged 30–70 years, had BCVA of 20/25 or better, and had no confounding ocular conditions. Blood was collected via fingerstick to determine Hemoglobin A1c (HbA1c), which was used along with previous diagnosis, to determine study grouping. Optical coherence tomography angiography (OCTA) was used to analyze the FAZ area and was corrected for refractive error. FAZ area was measured by hand using the Heidelberg Spectralis software. mfERG (VERIS 6.3) metrics implicit time (IT) and amplitude were evaluated in the foveal region, macular region, and averaged over the posterior pole of the right eye. Regression analysis was performed between each study group parameter to determine relationships, and t tests with corrections were used to compare groups. Results: FAZ area (superficial plexus) was negatively correlated with mfERG posterior pole amplitude (p < 0.01, R2 = 0.30), foveal amp (p = 0.02 R2 = 0.17) and macular amplitude (p = 0.02 R2 = 0.18) across all 33 study subjects. FAZ and mfERG metrics were not significantly different between study groups in this cohort except for IT, which was more delayed in the diabetes group compared to other groups. Conclusion: FAZ area is correlated with mfERG amplitudes but not IT. This suggests a link between the structural metrics and retinal function. Longitudinal follow-up work would be helpful to determine the timing of these changes in prediabetes. [ABSTRACT FROM AUTHOR]

Background: To perform a multimodal assessment of the ectopic inner foveal layers' (EIFL) prognostic role on idiopathic epiretinal membrane (ERM) surgery. Methods: We retrospectively followed-up for 12 months 27 patients who underwent ERM surgery and stratified them based on EIFL presence (group 1) or absence (group 2) at baseline. Central Retinal Thickness (CRT) and best-corrected visual acuity (BCVA) were compared pre- and post-operatively at 1, 4 and 12 months, whereas fixation stability (FS), macular sensitivity (MS) and multifocal electroretinogram (mfERG) responses were confronted at baseline and 12 months. Results: In group 1, BCVA improved at 4 and 12 months (MD = 0.14 (SE = 0.04); MD = 0.13 (SE = 0.05), respectively) as well as in group 2 (MD = 0.31 (SE = 0.07); MD = 0.41 (SE = 0.08), respectively). CRT did not change in group 1, whereas it decreased in group 2 at 4 and 12 months (MD = −73.13; SE = 23.56; MD = −76.20; SE = 23.56). MS showed no changes in both groups after surgery. FS did not change in group 1, whereas group 2 improved FS 2° (+8.91 ± 13.97) and FS 4° (+4.33 ± 3.84). MfERG P1 wave did not change in group 1, while in group 2 αP1-2, αP1-3 and αP1-4 improved postoperatively (27.97 ± 27.62; 12.51 ± 17.36; 10.49 ± 17.19, respectively). Conclusions: Multimodal assessment confirmed that EIFL negatively affected ERM surgery outcomes. [ABSTRACT FROM AUTHOR]

Objective: To observe the effect of three consecutive intravitreal injections of conbercept in the treatment of neovascular age-related macular degeneration (nAMD), to investigate the correlation between retinal anatomy and retinal function by spectral-domain optical coherence tomography (SD-OCT) and electroretinography (ERG), to evaluate the short-term clinical efficacy of conbercept in the treatment of nAMD, and to explore the value of ERG as a predictor of treatment efficacy. Method: A retrospective investigation was conducted on 36 patients (36 eyes) treated with intravitreal injections of conbercept at 0.5 mg a month for three consecutive courses. Data collected included the best corrected visual acuity (BCVA), central retinal thickness (CRT), retinal pigment epithelium (RPE) elevation volume in 1 mm-diameter (1RV), 3 mm-diameter (3RV), and 6 mm-diameter circles around the fovea (6RV), amplitude density and latency of the P1 wave in the multifocal electroretinography (mf-ERG) R1 ring and amplitude and latency in full-field electroretinography (ff-ERG) at baseline and monthly. The paired t test was used to compare the difference between pre- and posttreatment. Pearson correlation analysis was used to analyze the correlation between macular retinal structure and function. The difference was significant when p < 0.05. Results: At 12 weeks, the BCVA, CRT, 1RV, 3RV, 6RV, the P1 wave amplitude density of the mf-ERG R1 ring and the ff-ERG amplitude parameters were all significantly improved (p < 0.001). The BCVA in logMAR was positively correlated with CRT; 1RV, 3RV, and 6RV were negatively correlated with the amplitude density and latency of the mf-ERG R1 ring P1 wave. There were no severe ocular or systemic complications during the follow-up period. Conclusion: Conbercept is useful for the short-term treatment of nAMD. It can safely improve the visual acuity of affected eyes and restore the structure and function of the retina. ERG could serve as an objective indicator of function for evaluating the efficacy of and determining the need for retreatment during nAMD treatment. [ABSTRACT FROM AUTHOR]

Purpose: Considering the potential role of the peripheral retina in refractive development and given that peripheral refraction varies significantly with increasing eccentricity from the fovea, we investigated the association between relative peripheral refraction (RPR) and corresponding relative peripheral multifocal electroretinogram (mfERG) responses (electro‐retinal signals) from the central to the peripheral retina in young adults. Methods: Central and peripheral refraction using an open‐field autorefractor and mfERG responses using an electrophysiology stimulator were recorded from the right eyes of 17 non‐myopes and 24 myopes aged 20–27 years. The relative mfERG N1, P1 and N2 components (amplitude density and implicit time) of a mfERG waveform were compared with the corresponding RPR measurements at the best‐matched eccentricities along the principal meridians, that is at the fovea (0°), horizontal (±5°, ±10° and ± 25°) and vertical meridians (±10° and ± 15°). Results: The mean absolute mfERG N1, P1 and N2 amplitude densities (nV/deg2) were maximum at the fovea in both non‐myopes (N1: 57.29 ± 14.70 nV/deg2, P1: 106.29 ± 24.46 nV/deg2, N2: 116.41 ± 27.96 nV/deg2) and myopes (N1: 56.25 ± 15.79 nV/deg2, P1: 100.79 ± 30.81 nV/deg2, N2: 105.75 ± 37.91 nV/deg2), which significantly reduced with increasing retinal eccentricity (p < 0.01). No significant association was reported between the RPR and corresponding relative mfERG amplitudes at each retinal eccentricity (overall Pearson's correlation, r = −0.25 to 0.26, p ≥ 0.09). In addition, the presence of relative peripheral myopia or hyperopia at extreme peripheral retinal eccentricities did not differentially influence the corresponding relative peripheral mfERG amplitudes (p ≥ 0.24). Conclusions: Relative peripheral mfERG signals are not associated with corresponding RPR in young adults. It is plausible that the electro‐retinal signals may respond to the presence of absolute hyperopia (and not relative peripheral hyperopia), which requires further investigation. [ABSTRACT FROM AUTHOR]

Mohammed Iqbal,1 Ashraf Soliman,2 Ola Ibrahim,2 Ahmed Gad1 1Department of Ophthalmology, Faculty of Medicine, Sohag University, Sohag, Egypt; 2Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, EgyptCorrespondence: Mohammed Iqbal, Department of Ophthalmology, Faculty of Medicine, Sohag University, Sohag, 82425, Egypt, Tel +2 01068559840, Fax +2 093 2159080, Email dr_m_iqbal@yahoo.comPurpose: To analyze the outcomes of screen-time reduction on the foveal responses that associates computer vision syndrome (CVS) using multifocal electroretinogram (mfERG) examination.Methods: This prospective multicenter cohort comparative study included 49 eyes of 49 medical students divided into two groups. Group A (control group) included 25 eyes with no CVS diagnosis while group B (CVS group) included 24 eyes with CVS diagnosis. All students responded to the valid and reliable CVS-Form 3 (CVS-F3) questionnaire and underwent complete ophthalmic and mfERG examinations twice at the time recruitment in the study and four weeks after strict reduction of the daily screen-hours to ≤ 1 screen-hour daily to document associated foveal responses.Results: We documented statistically significant reduction in foveal responses in CVS versus control groups in mean mfERG Rings 1, 2, and 5 with Quadrants 1, 2, and 4 (P=< 0.0001, 0.0001, 0.0003, 0.001, 0.002, and 0.006, respectively). Following the screen-time reduction, the second mfERG examination revealed significant post-reduction improvements in foveal responses in CVS group particularly in mean mfERG Rings 1, 2, 3, and 5 with Quadrants 1 and 4 (P=< 0.0001, < 0.0001, 0.0005, 0.02, < 0.0001, and 0.04, respectively).Conclusion: This study documented the screen-induced foveal dysfunction that associates CVS using mfERG examination, which revealed remarkable significant improvements in foveal responses in the 4 weeks following strict screen-time reduction. These improvements were also associated with corresponding improvements in the visual performances. We suggest that the potential screen-induced foveal dysfunction outcomes might be reversible with strict screen-time reduction. We also recommend that educational institutional policies should limit online education-hours and redesign the mandated computer system use program to guard against visual sequelae of CVS.Clinical Trials Registration: ClinicalTrials.gov (ID: NCT04405648).Keywords: computer vision syndrome, digital eye strain, multifocal electroretinogram, screen-induced foveal dysfunction

Purpose: To provide an overview of the effect that the COVID-19 pandemic has had on visual electrophysiology referral patterns and the subsequent effect this may have on patients. Methods: All electrodiagnostic tests performed at Kensington Vision and Research Centre, Toronto Canada, in a 3-month period prior to the COVID-19 pandemic (1 September 2019 to 30 November 2019) were compared to a 3-month period after the start of the COVID-19 pandemic (1 September 2021 to 30 November 2021). Results: A total of 502 patients had electrodiagnostic testing carried out in the designated time periods: 292 in the time period prior to the COVID-19 pandemic and 210 patients after. There was a significant change in the reason for referral in patients pre-COVID compared to post-COVID (p = 0.004). There was a 43% reduction in referrals for drug monitoring, 25% reduction for hereditary pathology and a 27% increase in acquired pathology after the start of the COVID-19 pandemic compared to before. Conclusions: There was a substantial decrease in the total number of patients referred after the start of the COVID-19 pandemic compared to pre-COVID with inherited retinal pathology and drug monitoring patients being 2 populations most affected by the disruption to healthcare services. [ABSTRACT FROM AUTHOR]

Age-related macular degeneration (AMD) is a leading cause of blindness worldwide. In late-stage AMD, geographic atrophy (GA) of dry AMD or choroidal neovascularization (CNV) of neovascular AMD eventually results in macular atrophy (MA), leading to significant visual loss. Despite the development of innovative therapies, there are currently no established effective treatments for MA. As a result, early detection of MA is critical in identifying later central macular involvement throughout time. Accurate and early diagnosis is achieved through a combination of clinical examination and imaging techniques. Our review of the literature depicts advances in retinal imaging to identify biomarkers of progression and risk factors for late AMD. Imaging methods like fundus photography; dye-based angiography; fundus autofluorescence (FAF); near-infrared reflectance (NIR); optical coherence tomography (OCT); and optical coherence tomography angiography (OCTA) can be used to detect and monitor the progression of retinal atrophy. These evolving diverse imaging modalities optimize detection of pathologic anatomy and measurement of visual function; they may also contribute to the understanding of underlying mechanistic pathways, particularly the underlying MA changes in late AMD.

Introduction: The performance of "en face" optical coherence tomography (OCT) in screening for chloroquine (CQ) or hydroxychloroquine (HCQ) retinopathy has not been largely explored. The aim of this study was to determine the concordance of "en face" OCT with multifocal electroretinography (mfERG) in screening for CQ/HCQ retinopathy. Methods: This is a prospective cohort study conducted at the Rothschild Foundation Hospital, Paris, between August 2016 and February 2021. Patients taking HCQ were followed up over 2 consecutive years and received an "en face" OCT and a mfERG on each visit. Results: A total of 91 patients (182 eyes) were analyzed. mfERG and "en face" OCT were concordant in 147 eyes (86.3%). Cohen's kappa coefficient for concordance between mfERG and "en face" OCT was considered weak with a value 0.61 (95% CI: 0.50–0.72). The sensitivity and specificity of "en face" OCT were 70% (95% CI: 59–79%) and 91% (95% CI: 83–96%), respectively, relatively to mfERG. Proportion of abnormal R2/R5 and R3/R5 ratios did not differ between patients with normal and abnormal "en face" OCT (p = 0.2). Discussion: "En face" OCT and mfERG have low concordance and cannot be used interchangeably as each investigation evaluates a different facet of CQ/HCQ retinopathy. "En face" OCT could be used as a complement in screening for CQ/HCQ retinal toxicity if the anomalies detected on "en face" OCT are confirmed by B-scan OCT sections. [ABSTRACT FROM AUTHOR]

Jing Li, Wenjuan Wang, Xiaodan Zhang, Jinxing Liu, Haining Zhang, Tong Cui, Fangfang Wang, Guohong Zhou Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, People’s Republic of ChinaCorrespondence: Guohong Zhou, Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, No. 100 Fudong St, Xinghualing District, Taiyuan, 030002, Shanxi, People’s Republic of China, Email guohongzhou2005@163.comPurpose: To evaluate the multifocal electroretinogram (mfERG) and optical coherence tomography (OCT) angiography features in patients with idiopathic macular hole (IMH) before and after vitrectomy.Patients and Methods: This prospective study was conducted at Shanxi Eye Hospital from January 2019 to December 2021. Twenty-five eyes of 25 patients with unilateral IMH, the unaffected fellow eyes, and 30 eyes of healthy patients were investigated. All unilateral IMH eyes underwent vitrectomy.Results: The IMH eyes had significantly delayed latency (rings 2– 5) of mfERG compared with the healthy control eyes, and the amplitude density of all rings of mfERG was reduced (P < 0.05). When comparing the mfERG components before surgery and at the follow-up, the amplitude density of IMH eyes (ring 1, 3, 4 and 5) was increased significantly (P < 0.05). The delayed implicit times of the second and fifth ring were significantly shortened compared with those of preoperative eyes (P < 0.05). The mean delayed implicit time of mfERG in six months after surgery was negatively correlated with visual acuity (r = − 0.890, P = 0.043). Significant differences of superficial retinal blood flow density (SRBFD, P < 0.001) and choroidal blood flow density (CBFD) (P < 0.05) got via OCTA were found between IMH before surgery and healthy control eyes. SRBFD of the fellow eyes were significantly different with the healthy control eyes (P = 0.038). Statistically significance of SRBFD and CBFD changes in IMH eyes were found before and after surgery (P < 0.05).Conclusion: IMH eyes had a decreased amplitude density and a delayed implicit time in some regions. Additionally, SRBFD and CBFD were both increased after vitrectomy, which suggests that the blood supply of the retina and choroid is partially restored after vitrectomy.Keywords: idiopathic macular hole, multifocal electroretinogram, OCT-angiography, pars plana vitrectomy

Abstract Aim To study the short-term change of macular function and the correlates after intravitreal conbercept for CRVO-ME. Study design Prospective, clinical study. Methods Twenty Three patients(23 eyes) were recruited, who were non-ischemia central retinal vein occlusion diagnosed by FFA (fundus fluorescein angiography) and treated with intravitreal conbercept for macular edema, best – corrected visual acuity ( BCVA), central macular thickness(CMT), amplitude density of P1 wave and implicit time of P1,N1 wave from ring 1 and ring 2 of mf-ERG were measured before and 1 week、2 month after treatment. Results Compared to the baseline, BCVA、CMT、amplitude density of P1 wave and implicit time of P1,N1 wave from ring 1 and ring 2 were greatly improved at 1 W、2 M after treatment; better results were gained at 2 M compared to 1 W; Pearson correlation analysis shows no significantly correlation between the improvement of mf-ERG with the change of BCVA、CMT. Conclusion The BCVA、the structure and the function of macular were greatly improved after intravitreal conbercept for central retinal vein occlusion induced macular edema; however no significantly correlation between the improvement of the function of macular with the strcture of macular and BCVA.

(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. [ABSTRACT FROM AUTHOR]

Purpose: To assess the impact of neurodegenerative morphologic alterations due to macular telangiectasia type 2 (MacTel) on microperimetry (MP) and multifocal electroretinography (mfERG). Methods: Thirty‐five eyes of 18 patients with MacTel were examined using spectral domain optical coherence tomography (SD‐OCT), fundus autofluorescence (FAF), mfERG and MP. Software was used to match SD‐OCT B‐scans with the corresponding retinal sensitivity map and multifocal electroretinograms (mfERGs), thus enabling direct structure/function correlation. Results: Loss of the ellipsoid zone (EZ) had the strongest negative association with retinal sensitivity (16.77 dB versus 4.58 dB, adj. p < 0.001) of all parameters examined, and a limited negative effect on mfERGs (0.32 SD versus −1.97 SD adj. p = 0.121). Ellipsoid zone (EZ) irregularity was associated with reduced MP values but preserved mfERGs. There was a significant association between areas of inner retinal hyporeflectivity and loss of MP sensitivity (adj. p < 0.001) but the reduction in sensitivity was less than in locations with EZ loss. Areas of mfERG abnormality showed similar sensitivity loss with either inner retinal hyporeflectivity or EZ loss (adj. p = 0.063). In areas with EZ loss alone, preservation of the external limiting membrane (ELM) was associated with higher MP values than in areas with additional ELM loss; the integrity of the ELM alone was not associated with changes either in MP or mfERG. Increased FAF was observed in 51% of eyes, mixed/reduced FAF in 40%, and no abnormality was detected in 9% of eyes. Conclusion: The data suggest both MP and mfERG to be useful non‐invasive modalities for detecting localised macular dysfunction in MacTel. The findings suggest a different sensitivity of the two modalities to inner and outer retinal changes in macular function and are therefore complementary. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 ≤ 0.040). There was a significant reduction for N1 amplitude in all retinal regions (p < 0.001), while for P1 and N2 amplitudes this reduction was more significant in the peripheral regions (p < 0.005, ring 5 to 6). With center-near MF the mean response density (nV/deg2) showed a significant decrease in all wave components of the mfERGs response, particularly from Ring 3 to Ring 6 (p < 0.001, all Rings). In Exp#2, the mean mfERG response is similar between SVCL and center-distance MF, while center-near MF showed an increase in implicit time N1 and P1 on day 1 that tends to recover to baseline values after 15 days of MF wear. Conclusions: significant changes in the mfERGs responses were found with the MF lens, being most noticeable with the center-near MF lens design. The present results suggest that the observed delay in cortical response described during the adaptation to multifocality may partially begin at the retina level. [ABSTRACT FROM AUTHOR]

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

The measure of the full-field photopic negative response (ff-PhNR) of light-adapted full-field electroretinogram (ff-ERG) allows to evaluate the function of the innermost retinal layers (IRL) containing primarily retinal ganglion cells (RGCs) and other non-neuronal elements of the entire retina. The aim of this study was to acquire functional information of localized IRL by measuring the PhNR in response to multifocal stimuli (mfPhNR). In this case-control observational and retrospective study, we assessed mfPhNR responses from 25 healthy controls and from 20 patients with multiple sclerosis with previous history of optic neuritis (MS-ON), with full recovery of visual acuity, IRL morphological impairment, and absence of morpho-functional involvement of outer retinal layers (ORL). MfPhNR 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), and 20–25° (R5) from retinal sectors (superior-temporal (ST), superior-nasal (SN), inferior-nasal (IN), and inferior-temporal (IT)); between 5° and 20° and from retinal sectors (superior (S), temporal (T), inferior (I), and nasal (N)); and within 5° to 10° and within 10° and 20° from the fovea. The mfPhNR RAD values observed in all rings or sectors in MS-ON eyes were significantly reduced (p < 0.01) with respect to control ones. Our results suggest that mfPhNR recordings may detect localized IRL dysfunction in the pathologic condition of selective RGCs neurodegeneration. [ABSTRACT FROM AUTHOR]

Introduction: Administration of retinal gene and stem cell therapy in patients with retinal degenerative diseases is in many cases dependent on a subretinal approach. It has been indicated that manual subretinal injection is associated with outer retinal damage, which may be explained by a high flow rate in the injection cannula. In the present porcine study, we evaluated flow-related retinal damage after controlled subretinal injection at different flow rates. Methods: The flow rate through a 41G cannula was estimated at different injection pressures (6–48 pounds per square inch [PSI]) in an in vitro setup. A linear correlation between the flow rate and injection pressure was found from 6 to 32 PSI. In full anesthesia, 12 pigs were vitrectomized and received a controlled subretinal injection of 300 μL balanced saline solution at injection pressures of 14, 24, and 32 PSI (four in each group). Prior to surgery and 2 and 4 weeks after surgery, the eyes were examined by multifocal electroretinogram (mfERG) and fundus photographs. At the end of follow-up, the eyes were enucleated for histology. Results: The in vitro flow study determined that the flow in a 41G cannula shifts from laminar to turbulent at 32 PSI and that the manual injection flow is turbulent. In the porcine study, we showed a significant difference in retinal pigment epithelium (RPE) damage between the three pressure groups (p = 0.0096). There was no significant difference in damage to the outer retina (p = 0.1526), but the high-pressure group (32 PSI) had the most outer retinal damage. The middle-pressure group (24 PSI) showed minimum retinal damage. There was no significant change in the mfERG ratios during follow-up. Discussion/Conclusion: This study indicates that an injection pressure at approximately 24 PSI might be safe for subretinal delivery. Retinal damage at low injection pressures may be explained by mechanical damage to the RPE due to prolonged needle time in the subretinal space, while retinal damage at high pressures can be related to high flow in the injection cannula. Controlled subretinal injection pressure of 24 PSI showed minimum mechanical- and flow-related damage to the porcine retina. [ABSTRACT FROM AUTHOR]

Hydroxychloroquine and chloroquine play more and more important roles in the treatment of rheumatism, skin diseases and autoimmune diseases. Irreversible macular diseases,retinopathy and even permanent blindness are common side effects of them. High dose per kilogram of body weight, duration of treatment, presence or absence of keratosis and renal or liver dysfunction are all related to this. Therefore, the examination of the two kinds of drug lesions is also relatively complicated. FAF and SD-OCT are required for wide field examination. For patients with complicated retinopathy, multifocal electroretinogram and the like are also required for diagnosis. The specific examination methods need to be determined by clinical ophthalmologists according to the patient's medication and preliminary examination.

Khaled Abdelaziz,1 Mahrous Shaheen2 1Department of Ophthalmology, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt; 2Department of Ophthalmology, Faculty of Medicine, Fayoum University, Fayoum, EgyptCorrespondence: Khaled Abdelaziz, Email Khaled.ophthalmologist@yahoo.com

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.

Aim: To study the short-term change of macular function and the correlates after intravitreal conbercept for CRVO-ME.Study Design: Prospective, clinical study.Methods: Twenty Three patients(23 eyes) were recruited, who were non-ischemia central retinal vein occlusion diagnosed by FFA (fundus fluorescein angiography) and treated with intravitreal conbercept for macular edema, best - corrected visual acuity ( BCVA), central macular thickness(CMT), amplitude density of P1 wave and implicit time of P1,N1 wave from ring 1 and ring 2 of mf-ERG were measured before and 1 week、2 month after treatment.Results: Compared to the baseline, BCVA、CMT、amplitude density of P1 wave and implicit time of P1,N1 wave from ring 1 and ring 2 were greatly improved at 1 W、2 M after treatment; better results were gained at 2 M compared to 1 W; Pearson correlation analysis shows no significantly correlation between the improvement of mf-ERG with the change of BCVA、CMT.Conclusion: The BCVA、the structure and the function of macular were greatly improved after intravitreal conbercept for central retinal vein occlusion induced macular edema; however no significantly correlation between the improvement of the function of macular with the strcture of macular and BCVA. [ABSTRACT FROM AUTHOR]

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 < 0.0001; 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. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of Vogt-Koyanagi-Harada (VKH) syndrome-like posterior uveitis after nivolumab administration to treat an ovarian cancer with an electrophysiological finding. Case summary: A 61-year-old woman with ovarian cancer (stage 3A) and salpingo-oophorectomy surgery history visited the clinic complaining of blurred vision in both eyes. She had been enrolled a clinical trial using nivolumab in patients with ovarian cancer. She received four cycles of nivolumab administration and experienced blurred vision one week before the initial visit. There was no remarkable finding in the anterior segment and the vitreous body. Multiple subretinal fluid accumulations and serous retinal detachment were identified on the posterior pole. Subretinal fluid with choroidal folding was noted in optical coherence tomography, and multiple leakage points were also observed in wide-field fundus fluorescein angiography. Therefore, intravenous high-dose steroid pulse therapy was applied under the diagnosis of VKH syndrome-like posterior uveitis induced by an immunotherapy agent. After steroid therapy, the subretinal fluid was absorbed completely, and the patient's visual acuity was recovered to the normal range. The amplitudes in the multifocal electroretinogram were also restored after the treatment. Conclusion: Nivolumab is a human IgG4 monoclonal antibody and an immune checkpoint inhibitor. It is associated with the upregulation of T-cell activity by interfering with the interaction between the programmed death-1 (PD-1) receptor and the PD-ligand. Targeted therapy using immunotherapy agents has been widely used for malignant melanoma, lung cancer, renal cell carcinoma, and other cancers. However, immunotherapy agents such as nivolumab can induce autoimmune-related adverse events including uveitis. This report suggests that VKH syndrome-like posterior uveitis could be induced by nivolumab administration for an ovarian cancer treatment, which was resolved by steroid pulse therapy. [ABSTRACT FROM AUTHOR]

Purpose: Ideally, the multifocal electroretinogram (mfERG) is recorded without noticeable intrusion of mains interference. However, sometimes contamination is difficult to avoid. A post-processing digital notch filter can help to recover the retinal response even in severe cases of mains interference. While a digital filter can be designed to have little to no impact on peak times, filtering out mains interference also removes the retinal signal content of the same frequency, which may result in a change of amplitude. The present study addressed this issue in the standard first order kernel mfERG. Methods: In 24 recordings from routine exams with no perceivable mains interference, the effects of 50-Hz and 60-Hz non-causal digital notch filters on amplitude and peak time were assessed. Furthermore, the effect of filtering on contaminated traces was demonstrated and simulated mains interference was used to provide an example of nonlinear superposition of retinal signal and mains interference. Results: mfERG amplitudes were reduced by 0%–15% (median 6%) with the 50-Hz filter and remained virtually unaffected with the 60-Hz filter. Simulations illustrate that spurious high-frequency components can occur in the filtered signal if a strongly contaminated signal is clipped due to a limited input range of the analog-to-digital converter. Conclusion: The application of a 50-Hz digital notch filter to mfERG traces causes a mild amplitude reduction which will not normally affect the clinical interpretation of the data. The situation is even more favorable with a 60-Hz digital notch filter. Caution is necessary if the assumption of linear additivity of retinal signal and mains interference is violated. [ABSTRACT FROM AUTHOR]

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.

Abstract Background To compare the therapeutic effects of subthreshold micropulse laser (SML) versus intravitreal injection of ranibizumab in treatment of diabetic macular edema (DME) both anatomically using optical coherence tomography (OCT) and functionally using best corrected visual acuity (BCVA) and multifocal electroretinogram (mfERG). Methods his study was an interventional prospective randomized comparative study. The study included 120 eyes classified into 3 groups: Group 1 included 40 eyes of 28 patients treated by SML laser, group 2 included 40 eyes of 32 patients treated by intravitreal injection of ranibizumab, and group 3 (control group for mfERG) included 40 eyes of 20 patients with diabetes mellitus (DM) of more than 10 year duration with no signs of diabetic retinopathy (DR). BCVA measurements, OCT and mfERG were done for the cases before and after interference and were followed up for 6 months Results By the end of the follow up period, BCVA significantly improved by 31% in group 1 vs 93% in group 2 with a statistically highly significant difference between the two groups (p value

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.

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.

Background: Retinal dysfunction is widely documented in schizophrenia using flash (fERG) and pattern electroretinograms (PERG), but the role of dopamine transmission has seldom been explored.Methods: We explored the role of dopamine transmission by evaluating the spatial location of retinal anomalies using multifocal ERG (mfERG) in photopic condition and the oscillatory potentials (OPs) extracted from fERG measured in scotopic condition in 29 patients with schizophrenia and 29 healthy controls.Results: With the mfERG, our main results revealed reduced amplitudes in the center of the retina: P1 (p < .005) and N2 amplitudes (p < .01) in the <2° region, N1 (p < .0005) and P1 amplitudes (p < .001) in the 2-5° region and P1 amplitude (p < .05) in the 5-10° region. For OPs, our results showed a decrease in the O1 (p < .005), O2 (p < .005), O3 (p < .05) and overall O1, O2, O3 index amplitudes (p < .005) in patients with schizophrenia.Conclusions: Both the central location of retinal dysfunctions of the mfERG and OPs results could reflect a hypodopaminergic effect in patients with schizophrenia. In future studies, OPs should be considered as a measure to evaluate the hypodopaminergy in patients. [ABSTRACT FROM AUTHOR]

Objectives: To assess multifocal electroretinogram (mf-ERG) values in patients with diabetic macular edema (DME) who were treated with intravitreal ranibizumab (IVR). Methods: Thirty eyes of patients with DME, who underwent three consecutive monthly injections of IVR and as required thereafter, were evaluated. Best corrected visual acuity (BCVA) (log MAR), optical coherence tomography (OCT) features [diameters of cyst and subretinal fluid, hyperreflective dots (HRDs)], and mf-ERG were evaluated at baseline, 1 month, and 6 months throughout the follow-up period. The correlation of mf-ERG values and OCT features, BCVA, and the duration of disease were investigated. Results: In the study group, the baseline P1 and N1 amplitudes were significantly lower than the control group, and P1 and N1 implicit times were significantly higher in patients with DME than in the control group in all rings (All p<0.05) The mean response density (P1 amplitude, nV/deg2) values increased over 6 months in rings 1, 2, and 3 (p<0.001, p=0.003, p=0.006). There was a negative correlation between the diameter of the cyst and the initial response density of P1 (for horizontal diameter: r=-0.658, p=0.03; for vertical diameter: r=-0.597, p=0.037; for the area of the cyst, r=-0.603, p=0.021). There was a significant negative correlation between the subretinal fluid and HRD reduction and the response density of P1 increase (all p<0.05). At baseline and 6 months, the correlation between BCVA and the P1 and N1 amplitude of the central ring was significant (for baseline P1: r=-0.649, p=0.01; for N1: r=-0.575, p=0.02; for 6-month P1, r=-0.603, p<0.001; for N1: r=-0.591, p=0.005). Conclusion: The combination of OCT and mf-ERG can be used to evaluate the functional recovery in DME. [ABSTRACT FROM AUTHOR]

• 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. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of acute macular neuroretinopathy (AMN) in Behçet Disease. Case: A 23-year-old male presented with a complaint for central scotoma in his right eye. He had been diagnosed with Behçet Disease 3 years ago. Best-corrected visual acuity (BCVA) was 20/20. Anterior chamber and fundus examinations were unremarkable. Optical coherence tomography revealed a paracentral area of outer nuclear layer thinning. Infrared reflectance showed a well-defined, circular, hyporeflective area. Optical coherence tomography angiography revealed an area of capillary dropout in deep retinal capillary plexus corresponding to that hyporeflective lesion. Microperimetry test showed decreased macular sensitivity on the lesion area and the loss of the macular integrity. In multifocal electroretinogram, diminished amplitudes of the central cone responses were detected nasal to fixation. Conclusion: Behçet disease is a cause of occlusive retinal vasculitis. Accompanied retinal microvascular disease may be a possible risk factor of AMN suggesting ischemic etiopathogenesis for AMN. [ABSTRACT FROM AUTHOR]

Abstract 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

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 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

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 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 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.