Multifocal Electroretinography Research Articles

Vitamin A deficiency retinopathy in the setting of celiac disease and liver fibrosis.

Vitamin A is a lipid-soluble compound that is critical in maintaining phototransduction. Ocular manifestations of hypovitaminosis A may present with anterior segment signs of xeropthalmia, with advanced cases also causing classic retinal and electrophysiologic changes of vitamin A deficiency retinopathy. We present a case of vitamin A deficiency retinopathy, with corresponding retinal imaging and electrophysiology, in an adult patient with celiac disease and liver fibrosis. A single case report was conducted in Toronto, Canada. A 77-year-old male with known celiac disease and liver fibrosis presented progressively worsening vision noticed primarily when driving. Vision was 20/50 OD and 20/200 OS. Bitot spots were noted on anterior segment examination. Fundus photography demonstrated bilateral peripheral macular hypopigmentation and far-peripheral granular retinal hypopigmentation with focal yellow dots and hyper-pigmented deposits. Optical coherence tomography (OCT) imaging demonstrated indistinct outer retinal banding with mild outer nuclear layer thinning, focal hyper-reflective deposits, and a thin choroid bilaterally. Full-field electroretinography (ERG) testing demonstrated reduced rod-isolated and combined rod-cone response amplitudes, and multifocal ERG testing demonstrated blunted individual responses throughout the field. The patient was treated with pulse vitamin A therapy. After 6months of therapy, ERG responses were back within reference range, and the outer retinal changes reversed; visual acuity improved to 20/30 OD and 20/40 OS. This case represents the classic findings of vitamin A deficiency retinopathy on fundus examination and electrophysiologic testing secondary to gastrointestinal pathology. Prompt treatment of high dose vitamin A supplementation led to improvement of full-field and multifocal ERG results, as well as reconstitution of outer retinal architecture.

Adaptive optics retinal imaging in patients with usher syndrome

PurposeTo determine the structure of the cone photoreceptor mosaic in the macula in eyes with retinitis pigmentosa related to Usher syndrome using adaptive optics fundus (AO) imaging and to correlate these findings with those of the standard clinical diagnostics.MethodsTen patients with a genetically confirmed retinitis pigmentosa in Usher syndrome due to biallelic variants in MYO7A or USH2A were enrolled in the study. All patients underwent a complete ophthalmological examination including best corrected visual acuity (BCVA), spectral-domain optical coherence tomography (SD-OCT) with fundus autofluorescence photography (FAF), full-field (ffERG) and multifocal electroretinography (mfERG) and Adaptive Optics Flood Illuminated Ophthalmoscopy (AO, rtx1™, Imagine Eyes, Orsay, France). The cone density was assessed centrally and at each 0.5 degree horizontally and vertically from 1–4 degree of eccentricity.ResultsIn the AO images, photoreceptor cell death was visualized as a disruption of the cone mosaic and low cone density. In the early stage of the disease, cones were still visible in the fovea, whereas outside the fovea a loss of cones was recognizable by blurry, dark patches. The blurry patches corresponded to the parafoveal hypofluorescent ring in the FAF images and the beginning loss of the IS/OS line and external limiting membrane in the SD-OCT images. FfERGs were non-recordable in 7 patients and reduced in 3. The mfERG was reduced in all patients and correlated significantly (p <0.001) with the cone density. The kinetic visual field area, measured with III4e and I4e, did not correlate with the cone density.ConclusionThe structure of the photoreceptors in Usher syndrome patients were detectable by AO fundus imaging. The approach of using high-resolution technique to assess the photoreceptor structure complements the established clinical examinations and allows a more sensitive monitoring of early stages of retinitis pigmentosa in Usher syndrome.

Effects of Optical Zone Variation of High-Addition Multifocal Contact Lenses on the Global Flash Multifocal Electroretinography.

To evaluate the retinal response to myopic defocus after the wear of soft multifocal contact lenses with high addition through electroretinography. Twenty-seven participants meeting inclusion criteria were enrolled. Tropicamide 1% drops (2) were instilled. Participants were then fitted with three different contact lenses: a single-vision spherical lens (SE +3.00 D), L1, serving as a control, and two soft multifocal lens designs (SE +3.00 D/add +10 D), one with a central distance zone of 4.0 mm (L2) and one with a central distance zone of 7.0 mm (L3). A global flash multifocal electroretinography was performed. Direct component (DC) amplitude, DC peak time, induced component (IC) amplitude, and IC peak time were recorded. Waveforms were grouped into five concentric areas, covering from 0° to 24° of retinal eccentricity. Differences of L2/L3 versus L1 were analyzed with t tests. Finally, correlations were calculated between the percentage of defocus in the pupil area versus the electroretinography results. Results show that the DC amplitude, caused mainly by photoreceptors and bipolar cells, is not influenced by the design of the lenses. The IC amplitude, however, is significantly decreased when the lens with a smaller optical zone (L2) is worn. This significant difference only concerns the ring 5, which corresponds to a retinal eccentricity of 15.7° to 24.0°. Soft multifocal lens designs influence the peripheral retinal reaction to defocus. A larger treatment zone seems to significantly impact the retinal response to defocus between 15.7° and 24.0° of eccentricity from the macula.

Safety of repeated low-level red-light therapy for children with myopia

BackgroudTo investigate the safety of repetitive low-level red-light therapy (RLRLT) in children with myopia. MethodsChildren with myopia were assigned to the RLRL and control groups. Axial length (AL) and spherical equivalent refraction (SER) were followed up at 3-, 6-, and 12-month. To evaluate the safety of RLRLT, at 6 and 12 months in the RLRL group, multifocal electroretinography (mfERG) and contrast sensitivity were recorded. Furthermore, optical coherence tomography was used to measure the relative reflectance of the ellipsoid zone (rEZR), photoreceptor outer segment (rPOSR), and retinal pigment epithelium (rRPER). ResultsA total of 108 children completed the trial (55 in the RLRL group and 53 in the control group). After 3, 6, and 12 months, AL was shorter and SER less myopic in the RLRL group than in the control group. Regarding the safety of the RLRLT, the response density and amplitude of the P1 wave of the first ring of the mfERG increased significantly at 6 months (P = 0.001 and P = 0.017, respectively). At 6 and 12 months, contrast sensitivity at the high spatial frequency increased. Moreover, the rEZR increased significantly at 6 months (P = 0.029), the rPOSR increased significantly at 6 and 12 months (both P < 0.001), and the increase in rPOSR was greater with greater AL regression. ConclusionsBased on retinal function and structure follow-up, RLRLT was safe within 12 months. However, rEZR and rPOSR increased, the effects of this phenomenon requires further observation.

Evaluation of Structural and Functional Retinal Changes in Children With Intermittent Exotropia Versus Healthy Children.

To detect structural and functional changes in children with intermittent exotropia using optical coherence tomography, pattern electroretinography (ERG), and multifocal ERG. The study included 26 patients with intermittent exotropia and 26 healthy individuals matched for age and sex with a mean age of 9.23 and 11.20 years in the intermittent exotropia and control groups, respectively (P = .310). All patients underwent full ophthalmic examination including measurement of the angle of strabismus at near and far, and assessment of the macula and optic nerve using optical coherence tomography, pattern ERG, and multifocal ERG. All patients had 6/6 best corrected visual acuity with no fixation preference. A significantly prolonged P and N wave latency was found in all measured rings of multifocal ERG of patients with intermittent exotropia, P wave amplitude was lower in rings 1 and 5, and N wave amplitude was lower in rings 1 and 2. Regarding pattern ERG, the amplitude of P50 wave was lower and N95 latency was prolonged in the intermittent exotropia group. The upper and lower ganglion cell complex and the superior retinal nerve fiber layer were significantly thinner in the intermittent exotropia group compared to controls. Children with intermittent exotropia without any associated amblyopia or refractive error showed a subnormal pattern and multifocal ERG response in addition to a thinner ganglion cell layer and retinal nerve fiber layer compared to normal controls. This signifies that subtle structural and functional retinal changes are found in patients with intermittent exotropia. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Differences of ocular oscillations and neuro-retinal structures in patients with nystagmus caused by GPR143 and FRMD7 gene variants.

Mutations of G protein-coupled receptor 143 (GPR143) and FERM domain containing 7 (FRMD7) may result in congenital nystagmus (CN) in the first 6 months of life. We aimed to compare the differences in ocular oscillations between patients with these two gene mutations as well as the functional and structural changes in their retinas and visual pathways. Medical records were retrospectively reviewed to identify patients of congenital nystagmus with confirmed mutations in either GPR143 or FMRD7 genes from January 2018 to May 2023. The parameters of the ocular oscillations were recorded using Eyelink 1000 Plus. The retinal structure and function were evaluated using optical coherence tomography and multi-focal electroretinography (mERG). The visual pathway and optical nerve projection were evaluated using visual evoked potentials. The next-generation sequencing technique was used to identify the pathogenic variations in the disease-causing genes for CN. Twenty nystagmus patients of GPR143 and 21 patients of FMRD7 who had been confirmed by molecular testing between January 2018 and May 2023 were included. Foveal hypoplasia was detected only in patients with the GPR143 pathogenic variant. mERG examination showed a flat response topography in the GPR143 group compared to the FRMD7 group. VEP showed that bilateral amplitude inconsistency was detected only in the patients with GPR143 gene mutation. The amplitude and frequency of the ocular oscillations were not found to differ between patients with two different genetic mutations. Although the etiology and molecular mechanisms are completely different between CN patients, they may have similar ocular oscillations. A careful clinical examination and electrophysiological test will be helpful in making a differential diagnosis. Our novel identified variants will further expand the spectrum of the GPR143 and FRMD7 variants.

Multimodal imaging in deferasirox-mediated retinopathy.

Deferasirox is the only iron chelator available in oral formulation and a rare cause of pigmentary retinopathy. We report the first case of multimodal imaging in an adult with deferasirox retinopathy. Case report and literature review, with search terms including deferasirox retinopathy and deferasirox toxicity. A 63-year-old man with end stage renal disease and transfusion-dependent anemia on deferasirox for one year presented with asymptomatic pigment epitheliopathy. Optical coherence tomography featured outer retinal and retinal pigment epithelial discontinuity corresponding to hypoautofluorescence on fundus autofluorescence and blocking on fluorescein angiography. Multifocal electroretinography revealed subtle reduction in all amplitudes. Retinal examinations should be considered for patients requiring chronic administration of deferasirox.

Morphological and Functional Correlations in Acute Central Serous Chorioretinopathy

PurposeWe evaluate morphological and functional correlations in patients with acute central serous chorioretinopathy (CSC).MethodsA prospective study was conducted on 50 patients with an acute CSC episode lasting less than 3 months. At baseline, assessments included optical coherence tomography (OCT), best-corrected visual acuity (BCVA), contrast sensitivity (CS), microperimetry (MP), and multifocal electroretinography (mfERG). A correlation analysis between OCT morphological parameters (maximal subretinal fluid height (SRF), central retinal thickness (CRT), and macular volume (MV)) and functional parameters was conducted on the affected eye for each patient.ResultsAmong the morphological parameters, SRF showed the strongest correlations with functional parameters (r absolute value range = 0.10–0.70). Weak correlations were observed between BCVA and morphological parameters (r absolute value range = 0.14–0.26). Average retinal sensitivity (MP-A) was the functional parameter displaying the most robust negative correlation with morphological parameters (r absolute value range = 0.61–0.70). In contrast, average contrast sensitivity (CS-A) and mfERG average amplitude density in the first (mfERG-A1) and second (mfERG-A2) ring showed weak to moderate (r absolute value range = 0.35–0.56) yet statistically significantly nonzero correlations.ConclusionsSRF and CRT could serve as the most representative morphological proxies for visual function deficit in acute CSC patients. Retinal sensitivity, as measured by MP, may be superior to BCVA in clinical research studies or when an in-depth visual function evaluation is needed.

New proposal for a multimodal imaging approach for the subclinical detection of hydroxychloroquine-induced retinal toxicity in patients with systemic lupus erythematosus

ObjectiveTo compare multimodal structural and functional diagnostic methods in patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine, to identify the best complementary approach for detecting subclinical retinal toxicity.MethodsA cross-sectional,...

Evaluation of Full-Field Stimulus Threshold Test Results in Retinitis Pigmentosa: Relationship with Full-Field Electroretinography, Multifocal Electroretinography, Optical Coherence Tomography, and Visual Field.

The full-field stimulus threshold (FST) test was developed to evaluate the efficacy and safety of treatments of hereditary retinal diseases. In this study we performed the FST test in patients with retinitis pigmentosa (RP) and compared the results with findings from other ophthalmological tests. The study included 51 intermediate and advanced RP patients and 21 normal subjects. All patients and controls underwent routine examination and ophthalmological tests including visual field, optical coherence tomography, full-field and multifocal electroretinography (mfERG), and FST tests. During FST testing, the perception thresholds of retina to the white, blue, and red FST were determined in decibels. The mean age of the patients and the controls were 35.2 and 33.5 years, respectively. For all RP patients, no response was obtained on full-field ERG. All subjects were able to perform reliable FST tests. The mean values of visual acuity and central macular thickness were significantly lower and visual field mean deviation values were significantly higher in the RP group than the controls. When we evaluated the mfERG findings, the mean P1 wave amplitudes in all rings were significantly lower and the mean peak times were significantly longer in RP patients than controls. In comparisons of FST test results, the mean values for white, blue, red and the difference between blue-red thresholds were significantly lower in the RP group than the control group. The FST test is a fast and a reliable exam which can be done in subjects with poor visual acuity and reduced visual field. The results of this study confirm that the FST test can measure retinal sensitivity in severely affected RP subjects with flat flash ERG.

Adult-onset neuronal intranuclear inclusion disease related retinal degeneration: a Chinese case series.

To evaluate adult-onset neuronal intranuclear inclusion disease (NIID)-related retinopathy with guanine-guanine-cytosine repeat expansions in NOTCH2NLC. Neuro-ophthalmic evaluations, including best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure (IOP), ultrasound biomicroscopy, pupillometry, fundus photography, fundus autofluorescence (FAF), optical coherence tomography (OCT), Humphrey visual field, full-field electroretinography (ERG), and multifocal ERG (mf-ERG) were performed in patients with gene-proven NIID. Nine patients (18 eyes) were evaluated, with a median age of 62 years (55-68) and only one man was included in our study. Six patients presented with decreased visual acuity or night blindness, whereas the other three were asymptomatic. The visual acuity was measured from 20/200 to 20/20. Miosis was present in eight patients, four of whom had ciliary process hypertrophy and pronation, and three of whom had shallow anterior chambers. Fundus photography, FAF, and OCT showed consistent structural abnormalities mainly started from peripapillary areas and localized in the outer layer of photoreceptors and inner ganglion cell layer. ERG and mf-ERG also revealed retinal dysfunction in the corresponding regions. Patients with NIID showed both structural and functional retinopathies which were unique and different from common cone-rod dystrophy or retinitis pigmentosa. Patients with miosis may have a potential risk of an angle-closure glaucoma attack. Neuro-ophthalmic evaluations is essential for evaluating patients with NIID, even without visual symptom.

Multifocal electroretinography in the diagnosis and monitoring of early and intermediate stages of age-related macular degeneration

Multifocal electroretinography is a valuable diagnostic method for the objective localization and quantitative assessment of functional disorders of the central retina in age-related macular degeneration. It is used to detect early changes, monitor the course of the disease and treatment outcomes. In many cases, multifocal electroretinography is a more sensitive method for detecting functional disorders at the early/intermediate stage of age-related macular degeneration compared to morphological (optical coherence tomography) and subjective (visual acuity, perimetry) testing methods.

Multimodal topographically oriented approach to the study of full-thickness macular holes

This article studies the relationship between structural changes according to the findings of optical coherence tomography (OCT) and OCT angiography (OCTA), microperimetry (MP), multifocal electroretinography (mfERG) parameters in topographically corresponding areas of the macular region in idiopathic full-thickness macular holes (FTMH). OCT, OCTA, MP and mfERG were performed in 14 eyes with FTMH stages I-IV according to Gass. In 13 points at a distance of 0-2.5°, 2.5-5.0°, and 5.0-10.0° from the fixation point, the light sensitivity (LS), amplitude and latency of the P1 component were compared with the size of the hole, the area of cystic changes (CC) at the level of the inner nuclear layer (INL) and the outer plexiform layer and Henle fiber layer complex (OPL+HFL), vessel density in the superficial and deep capillary plexus (SCP and DCP). LS and P1 component amplitude were significantly reduced at a distance of up to 5.0° from the fixation point. LS correlates with the apical and basal diameter of the hole (R> -0.53), the area of CC in the INL (R> -0.62) and the OPL+HFL complex (R> -0.55), the density of vessels in the SCP at a distance of up to 2.5° from the fixation point (R>0.51) and in the DCP at a distance of up to 5° from the fixation point (R>0.49). The P1 amplitude correlates with the basal diameter of the hole (R= -0.38), the area of CC in the INL and the OPL+HFL complex (R> -0.33) and vessel density in the SCP (R=0.37) at a distance of up to 2.5° from the fixation point, as well as vessel density in the DCP at a distance of up to 5° from the fixation point (R=0.47). Vessel density in the DCP is significantly lower in the presence of CC in the retina (p<0.001). In FTMH, there is a relationship between bioelectrical activity and LS, and structural disorders, capillary perfusion in different layers of the retina. A multimodal topographically oriented approach allows studying the relationship between structural and functional parameters in individual points of the retina and can be used in monitoring of FTMH after surgical treatment.

Влияние исходных структурных нарушений и послеоперационного изменения перфузии на функциональное восстановление сетчатки после хирургического лечения сквозных макулярных разрывов

Purpose. To evaluate effect of preoperative local structural retinal changes and capillary perfusion in idiopathic full-thickness macular holes (FTMH) on the recovery of functional activity of the retina after surgical treatment. Materials and methods. We used optical coherence tomography (OCT) and OCT-angiography (OCT-A), microperimetry, multifocal electroretinography. In 25 eyes with FTMH the density of capillaries in the superficial and deep capillary plexus (SCP and DCP), retinal sensitivity (RS), amplitude and implicit time of P1 were studied at 13 points located at different distances from the fixation point were evaluated. Data were analyzed in the projection of the hole, intraretinal cystic changes (ICC), neuroepithelial detachment (NED) and intact retina before surgical treatment, 7 days, and 3 months after. Results. In the area of hole, ICC, and NED, in comparison with intact areas of the retina, a significant decrease in RS, an increase in implicit time and a decrease in amplitude of P1, and a decrease in capillary density in the SCP and DCP were revealed. Functional restoration of the retina with an increase in its perfusion was noted 3 months after the surgery. The correlation was found between postoperative changes in RS and changes in capillary density in the SCP in the projection of NED (R=0.32, p=0.001) and ICC (R=0.19, p=0.001), as well as in the DCP in the projection of NED and ICC (R=0.31, p=0.001). The change in the amplitude P1 in the postoperative period significantly correlated with the change in perfusion in the SCP in the projection of the NED (R=0.38, p=0.001) and the hole area (R=0.31, p=0.001), as well as in the DCP in the projection of the ICC (R=0.31, p=0.01) and in the area of NED (R=0.28, p=0.001). Conclusion. Thus, when using a multimodal topographically oriented approach, a relationship was found in the postoperative period of changes in functional parameters at various points in the macular area with changes in local perfusion at the level of both SCP and DCP, while the relationship is most significant in the projection of NED along the tear edge and in the areas of ICC. Key words: full-thickness macular hole (FTMH), microperimetry, multifocal electroretinography, multimodal imaging, optical coherence tomography, optical coherence tomography-angiography

Contributed Session III: AAV-mediated gene therapy for PDE6C achromatopsia: Progress and challenges.

To determine the clinical circumstances under which viral mediated gene therapy can rescue cone function in a nonhuman primate model of PDE6C achromatopsia. Infant rhesus macaques homozygous for the PDE6C R565Q mutation were generated through a breeding program at the California National Primate Research Center. Homozygotes were treated in the right eye with adeno-associated virus (AAV5) carrying rhesus PDE6C under the control of the PR1.7 cone-specific promoter. The left eye was used as a control. Animals were tested by full-field and multifocal electroretinography. A total of 7 animals have been treated. The virus was found to be safe, but with variable inflammatory response. There were no obvious alterations in retinal lamination in treated eyes. The virus was expressed specifically in cone photoreceptors. Pre- and post-treatment systemic steroids led to minimal to moderate inflammatory response. In general, the gene therapy partially restored the cone responses on ERG within one month of injection in infants, but not in the older animals. If restored, the rescued cone responses were sustained and durable for over a year. Chromatic ERG testing showed restoration of amplitudes in all three cone subtypes. AAV-mediated gene therapy partially restored cone function and was relatively durable. Inflammation and age of administration may be important to outcomes. Similar approaches in human patients may warrant investigation.

Role of Electrophysiologal Studies for Detection of Simulation and Aggravation in Ophthalmology

Abstract Objective To present the importance of the electrophysiological studies for detection of malingering and aggravation in ophthalmology. Materials and methods Six eyes of three patients underwent a complete clinical examination, fundus-autofluorescence (FAF), fluorescein angiography (FA), optical coherence tomography (OCT), visual field testing, electrophysiological (EF) studies – full-field, multifocal and pattern electroretinography (ffERG, mfERG and PERG) and visual evoked potentials (VEPs), for detection of simulation or aggravation. Results After the electrophysiological studies’ results, which are objective and non-manipulable, we purposefully reviewed and repeated some of the tests already done, which allowed a comprehensive interpretation of the results. It turned out that discrete changes in targeted search can be detected in several of the studies performed, which greatly facilitates the correct diagnosis. Conclusion EF studies are objective methods for studying the visual analyzer’s function, that can not be manipulated, which makes them indispensable for detecting simulation and aggravation in ophthalmology. A detailed extensive study of the degree of simulation and aggravation among the ophthalmological patients is needed, which will enrich our knowledge and make us more precise in our expertise.

Evaluations of microvascular density by optical coherence tomography, angiography, and function by multifocal electroretinography of the macular area in eyes with branch retinal artery occlusion

IntroductionIt is reported that eyes with a branch retinal artery occlusion (BRAO) had normal full-field electroretinography (ERG) but the response of the multifocal electroretinography (mfERG) was reduced in the area of the arterial occlusion. Optical coherence tomography angiography (OCTA) is a recently appeared modality that can evaluate microvascularizations in different retinal layers and in different regions of the retina. The purpose of this study was to determine the density of the microcirculation and the function of the macular area of eyes with BRAO, and to determine whether they are significantly correlated.MethodsThe OCTA and mfERG findings of 7 eyes of 6 patients (3 men, 3 women) were studied. The mean age of the patients was 71.7±10.6 years. The OCTA examinations were made with volume scans of 3 × 3 and 6 × 6 mm squares centered on the fovea. The macular vessel densities (mVD) in the superficial retinal layer (SRL) and deep retinal layer (DRL) were measured for the superior and inferior halves of 3 × 3 and 6 × 6 mm diameter concentric circles. The mfERGs were recorded with targets set to stimulate the focal areas of the retina corresponding to the areas examined by OCTA.ResultsThe OCTA examinations showed that the mVD of the 3 mm concentric circle in the SRL was significantly lower on the affected side than on the unaffected side (P = 0.022). No such difference was observed in the DRL. The N1 amplitude of the 20.2° concentric circle and the N1–P1 amplitude of the 10.1° concentric circle of the mfERGs were significantly smaller on the affected side than on the unaffected side (P = 0.047 and 0.031). A significant positive correlation was found between the mVD of the 6 mm concentric circle in the DRL and the P1–N2 amplitude of the 20.2° concentric circle (ρ = −0.929 and p = 0.003).DiscussionThese findings indicate that OCTA images may be able to show changes in the density of the retinal macular microcirculation, and the mfERGs may be able to show alterations in the function of the macular area of the eyes with BRAO. A layer-by-layer analysis of the local retinal microcirculation and function should help in determining the pathogenesis of BRAO.

The role of multifocal electroretinography in the preclinical diagnosis of tumor-associated distant maculopathy in small melanoma of the choroid of extramacular localization

To assess the role of multifocal electroretinography (mf-ERG) in preclinical diagnosis of tumor-associated distant maculopathy in small choroidal melanoma (CM) of extramacular localization.Material and methods. 35 patients (35 affected and 35 fellow eyes) with small CM of extramacular localization and 23 healthy volunteers (46 eyes) aged 59.67 ± 14.2 years were given general ophthalmological examinations and mf-ERG. Density (nV/deg2), culmination time of the P1 component and amplitude (μV) of the N1 component were measured for 5 response rings (R1–R5) at different distances from the fixation point: central hexagon R1: 2.3° (fovea zone); R2: 2.3–6.9° (parafovea); R3: 6.9–14.3° (perifovea); R4: 14.3–20.8° and R5: 20.8–29.9° (middle periphery areas of the retina).Results. Eyes affected by CM showed a decrease in the density of the P1 component in the R1 hexagon by 25.7% of the normal values (p = 0.03). The fellow eyes showed an increase in the density of the P1 component in the R2 ring (p &lt; 0.05). The peak latency of the P1 component in the R1–R5 rings in the affected and fellow eye was found to elongate by 30–45% (p &lt; 0.05). The amplitude of the N1 component in the central hexagon of CM-affected eyes increased by 12.96%, whilst in the R4–R5 rings it decreased by 36–45% as compared with healthy individuals (p &lt; 0.05). The fellow eye showed supernormal values of the N1 amplitude in R1 and its suppression in R4 and R5 rings (p &lt; 0.05).Conclusion. The mf-ERG method is useful for preclinical diagnosis of tumor-associated distant maculopathy in small CM of extramacular localization. Changes in mf-ERG of the fellow eye in patients with small CM have been documented.

Suprachoroidal spheroidal mesenchymal stem cell implantation in retinitis pigmentosa: clinical results of 6 months follow-up

PurposeThis prospective clinical case series aimed to evaluate the effect of suprachoroidal implantation of mesenchymal stem cells (MSCs) in the form of spheroids as a stem cell therapy for retinitis pigmentosa (RP) patients with relatively good visual acuity.MethodsFifteen eyes of 15 patients with RP who received suprachoroidal implantation of MSCs in the form of spheroids were included. Best-corrected visual acuity (BCVA), 10–2 and 30–2 visual field examination and multifocal electroretinography (mfERG) recordings were recorded at baseline, postoperative 1st, 3rd and 6th months during follow-up.ResultsBaseline median BCVA of RP patients was 1.30 (1.00–2.00) logMAR. BCVA has improved to 1.00 (0.50–1.30), 0.80 (0.40–1.30) and 0.80 (0.40–1.30) at the postoperative 1st, 3rd and 6th months, respectively. The improvements from baseline to the 3rd and 6th months were statistically significant (p = 0.03 and p < 0.001, respectively). In the 30–2 VF test, median MD was significantly improved at the 6th month compared to baseline (p = 0.030). In the 10–2 VF test, the median MD value was significantly different at the 6th month compared to the baseline (p = 0.043). The PSD value of the 10–2 VF test was significantly different at the 6th month compared to the 3rd month (p = 0.043). The amplitudes of P1 waves in < 2°, 5°–10° and 10°–15° rings improved significantly at the postoperative 6th month (p = 0.014, p = 0.018 and p = 0.017, respectively). There was also a statistically significant improvement in implicit times of P1 waves in 10°–15° ring at the postoperative 6th month (p = 0.004).ConclusionSuprachoroidal implantation of MSCs in the form of spheroids as a stem cell therapy for RP patients with relatively good visual acuity has an improving effect on BCVA, VF and mfERG recordings during the 6-month follow-up period. Spheroidal MSCs with enhanced effects may be more successful in preventing apoptosis and improving retinal tissue healing in RP patients.

Assessment of Macular Function by Multifocal Electroretinography Following Idiopathic Epiretinal Membrane Surgery with Internal Limiting Membrane Peeling

Purpose To evaluate macular function before and after vitrectomy for idiopathic epiretinal membrane (ERM) with internal limiting membrane (ILM) peeling by multifocal electroretinography (mfERG) and their correlations with visual acuity (VA) and central subfoveal thickness (CST) by optical coherence tomography (OCT). Settings and Design A prospective interventional case series of 15 eyes with idiopathic ERM of 14 patients who underwent pars plana vitrectomy (PPV) for ERM removal with ILM peeling. Methods Multifocal electroretinography (mfERG) and OCT were performed preoperatively and one month after surgery. The response amplitude densities and implicit times of mfERG were analyzed. Correlation analyses among visual acuity, CST and mfERG values in the five concentric rings were performed. Results The first order responses of mfERG recorded preoperatively showed diffuse reduction in P1 amplitudes in all 5 rings with no statistically significant differences in mfERG responses after ERM surgery. Correlation coefficients showed a significant correlation between postoperative VA and P1 amplitude of ring 2 (P = 0.005). There was no significant correlation between postoperative CST and P1 amplitude for all rings Conclusions The mfERG responses in eyes with idiopathic ERM show macular function abnormalities and correlate with VA after surgery. The residual retinal distortion along with the damage to inner retinal layers and Muller cell dysfunction associated with ILM peeling affect the mfERG responses after surgery. The incorporation of mfERG into the pre- and post-operative assessment of patients with iERM, allow for identification of functional impairment and predict visual outcomes.