Evaluation of successful macular hole surgery by optical coherence tomography and multifocal electroretinography

Chan

Survey of Ophthalmology

et al. 2007

Abstract. Multifocal electroretinography (mfERG) is an investigation that can simultaneously measure multiple electroretinographic responses at different retinal locations by cross-correlation techniques. mfERG therefore allows topographic mapping of retinal function in the central 40--50 of the retina. The strength of mfERG lies in its ability to provide objective assessment of the central retinal function at different retinal areas within a short duration of time. Since the introduction of mfERG in 1992, mfERG has been applied in a large variety of clinical settings. This article reviews the clinical applications of mfERG based on the currently available evidence. mfERG has been found to be useful in the assessment of localized retinal dysfunction caused by various acquired or hereditary retinal disorders. The use of mfERG also enabled clinicians to objectively monitor the treatment outcomes as the changes in visual functions might not be reflected by subjective methods of assessment. By changing the stimulus, recording, and analysis parameters, investigation of specific retinal electrophysiological components can be performed topographically. Further developments and consolidations of these parameters will likely broaden the use of mfERG in the clinical setting.

Section: Central Serous Chorioretinopathymentioning

confidence: 86%

Section: Central Serous Chorioretinopathymentioning

confidence: 99%

See 1 more Smart Citation

The Clinical Applications of Multifocal Electroretinography: A Systematic Review

Chan

Survey of Ophthalmology

et al. 2007

“…3,4 OCT has been mainly used for evaluating various types of retinal diseases, glaucoma, and optic nerve diseases. [5][6][7][8][9][10][11][12][13][14] In eyes with macular disease such as occult macular dystrophy, and various types of macular oedema, foveal thickness have shown a correlation with visual acuity, and alterations of macular thickness have been adopted in assessing progress of disease. [15][16][17][18] On the other hand, some studies remarked and demonstrated the decrease in peripapillary RNFL thickness in eyes with glaucoma, traumatic optic neuropathy, and compression optic neuropathy using OCT. [9][10][11][12][13][14]19,20 Although it has been reported that peripapillary RNFL thickness represents the severity of visual field loss and would be of clinical use, 14,21 little attention have been paid to the relationship between visual function and macular thickness in eyes with optic nerve disease.…”

Section: Introductionmentioning

confidence: 99%

Macular thickness reduction in eyes with unilateral optic atrophy detected with optical coherence tomography

Kusuhara

Nakamura

Nagai-Kusuhara

et al. 2005

Eye

Aims To assess the changes in macular and peripapillary retinal nerve fibre layer (RNFL) thickness in eyes with unilateral optic atrophy and to evaluate the relationship between retinal thickness and visual function. Methods Enrolled were 22 patients with unilateral optic atrophy. Macular thickness at the divided nine areas and peripapillary RNFL thickness in quadrantic sections were measured by optical coherence tomography. Thickness values in the affected eyes were compared with those in the contralateral unaffected eyes. The correlation of foveal thickness with best-corrected visual acuity (BCVA) was evaluated. The correlation between retinal thickness and the remaining visual field area circumscribed with I-4-e isopter in superior and inferior hemifield was assessed.Results Macular thinning was observed in all areas (Po0.001 in each area) other than the fovea (P ¼ 0.068). Peripapillary RNFL thickness decreased in all quadrantic sections (Po0.001 in each section). The affected to unaffected eye ratio of retinal thickness was more than 0.6 in each area. BCVA did not correlate with foveal thickness (correlation coefficient ¼ 0.094, P ¼ 0.668). Although not statistically significant (P ¼ 0.281, superior hemifield; P ¼ 0.053, inferior hemifield), there was a tendency that eyes with severe visual field loss show more marked retinal thinning. Conclusions Macular thinning with the preserved foveal thickness is a hallmark of eyes with optic atrophy. Together with no correlation between foveal thickness and BCVA, this finding would help in differential diagnosis of macular and optic nerve diseases.

“…26 The configuration of macular holes on OCT can be predictive of postoperative visual outcome. 11,27,28 Ultrahigh-resolution OCT offers enhanced visualisation of retinal architecture providing additional detailed information on the morphology of macular disease. 29 High-speed OCT offers three-dimensional imaging of macular holes that facilitates the understanding of abnormalities in the vitreofoveal interface.…”

Section: Pathogenesis Of Macular Holesmentioning

confidence: 99%

Macular holes: vitreoretinal relationships and surgical approaches

Bainbridge

Herbert

Gregor

2008

Eye

100

Idiopathic full-thickness macular holes develop as a result of anteroposterior and tangential traction exerted by the posterior vitreous cortex at the fovea. Vitreoretinal relationships during the development of macular holes can be demonstrated in detail by ocular coherence tomography, facilitating an improved understanding of their pathogenesis and guiding clinical management. Surgical strategies for the repair of macular holes are designed to relieve vitreofoveal traction and to promote flattening and reapposition of the macular hole edges by intraocular gas tamponade. A period of facedown positioning postoperatively is conventionally advised. However, the evidence to support this recommendation is weak and practice varies considerably. Surgical removal of the inner limiting membrane (ILM) is advocated to ensure thorough removal of any tangential tractional components including any residual cortical vitreous. Current evidence suggests that ILM peeling can improve anatomical outcomes but the effect on visual function is less predictable; unsuccessful attempts to peel the ILM can be associated with poor visual outcome. The use of vital dyes can facilitate visualisation of the ILM and help achieve complete, atraumatic peeling. Indocyanine green dye can enable high rates of macular hole closure but has been associated with poorer visual outcomes suggesting a dosedependent toxicity. Trypan blue dye offers an alternative that may have a more favourable risk profile. An improved understanding of vitreoretinal relationships may facilitate a tailored approach to surgery in individuals with macular holes. Vitrectomy to relieve anteroposterior traction is central in the management of all full-thickness holes. The use of long-acting gases, prolonged face-down positioning, and ILM peeling may be more valuable for larger holes, longstanding holes, and those that have failed to close following conventional surgery.