Short-term Efficacy and Safety of Intravitreal Brolucizumab Injection for Treatment-Naive Exudate Age-related Macular Degeneration: A Multicenter Study

Purpose@#To compare short-term efficacy and safety of intravitreal brolucizumab injection with aflibercept in treatment-naive neovascular age-related macular degeneration (nAMD) patients. @*Methods@#A total of 59 eyes from 59 treatment-naive nAMD patients in three hospitals were retrospectively reviewed. Of which, 27 patients underwent intravitreal brolucizumab injections and 32 received aflibercept. After monthly consecutive three injections, best-corrected visual acuity (BCVA; in logarithm of minimal angle of resolution [logMAR]), central macular thickness (CMT), dry macula achievement rate, and intraocular inflammation (IOI) incidence were compared. @*Results@#After loading-phase treatment, BCVA was significantly increased from 0.48 ± 0.30 logMAR at baseline to 0.33 ± 0.21 logMAR at 3 months in the brolucizumab group (p = 0.002) and 0.40 ± 0.39 logMAR at baseline to 0.33 ± 0.36 logMAR at 3 months in the aflibercept group (p = 0.007). But there was no significant difference in BCVA improvement at 3 months between the two groups. CMT significantly decreased from 429.67 ± 250.59 μm at baseline to 210.67 ± 93.53 μm at 3 months in the brolucizumab group and from 346.69 ± 159.09 μm to 234.52 ± 83.42 μm in the aflibercept group (both p < 0.001). The amount of CMT reduction was significantly greater in the brolucizumab group after 3 months (p = 0.036). In typical AMD eyes, brolucizumab showed similar BCVA improvement but better CMT reduction at 3 months (p = 0.018). Dry macula achievement rate was not significantly different between the two groups. One IOI was observed in the brolucizumab group. @*Conclusions@#Intravitreal injections of brolucizumab and aflibercept showed similar anatomical and functional outcomes. But CMT reduction was greater in the brolucizumab group. One IOI was identified, which was tolerable for topical agents. These results suggest that brolucizumab could be a novel first line treatment option for treating naive nAMD patients.

Peripheral Lattice Degeneration Imaging with Ultra-Widefield Swept-Source Optical Coherence Tomography

Purpose@#To investigate a series of peripheral lattice degeneration cases using an ultra-widefield (UWF) swept-source optical coherence tomography (SS-OCT) system. @*Methods@#From August 1, 2022 to July 31, 2023, 19 eyes from 16 patients with peripheral lattice degeneration were included. They all underwent a UWF SS-OCT examination. Anatomy of retina, vitreous, and associated pathologic changes were assessed. @*Results@#UWF SS-OCT showed various anatomical changes of retina and vitreous in patients with lattice degeneration. Of 15 eyes from 12 patients whose UWF SS-OCT images were clearly obtained, eight eyes showed regional retinal thinning, seven eyes showed vitreous traction, two eyes showed detached vitreous, and three eyes showed retinal break. @*Conclusions@#UWF SS-OCT can be a useful tool to understand anatomical changes and pathophysiology of peripheral lattice degeneration.

Experimental Assessment of the Performance of Dual Pneumatic Vitreous Cutters According to Gauge and Cut Rate

Purpose@#To compare and analyze the performance of dual pneumatic ultra-high-speed vitreous cutters based on their cut rates, vacuum levels, and diameters in terms of flow rate and cutting time. @*Methods@#The Constellation Vision System was used to remove egg white for 30 seconds, after which we calculated the flow rate by measuring the change in weight. We then measured the time required to remove 4 mL of egg white. We tested the UltraVit (UV) 7,500 cuts per minute (cpm) probe and the Advanced UltraVit (AUV) 10,000 cpm probe in biased open duty cycle mode, using 23-, 25-, and 27-gauge probes, respectively. @*Results@#In biased open duty cycle, the flow rate tended to decrease as the cut rates increased for all three gauges. At the same cut rates, the flow rate increased as the vacuum level increased (p < 0.05), and as the diameter increased (p < 0.05). Among cutters with the same diameter, the AUV cutter showed higher flow rates than the UV cutter, with increases of 0.267 mL/min (18.5%) at 27 gauge, 0.627 mL/min (20.8%) at 25 gauge, and 1.000 mL/min (20.7%) at 23 gauge (all p < 0.05). The times required to remove 4 mL of egg white took longer with the UV cutter than the AUV cutter for all three gauges (all p < 0.05). @*Conclusions@#The use of a smaller gauge vitreous cutter may reduce the flow rate and increase the time required for vitrectomy, but this can be partially compensated for by increasing the vacuum level as well as using a vitreous cutter with a higher maximum cut rate, improved port size, and improved duty cycle.

Methodology and Rationale for Ophthalmic Examinations in the Seventh and Eighth Korea National Health and Nutrition Examination Surveys (2017–2021)

This report provides a detailed description of the methodology for ophthalmic examinations according to the Korea National Health and Nutrition Examination Survey (KNHANES) VII and VIII (from 2017 to 2021). The KNHANES is a nationwide survey which has been performed since 1998 in representatives of whole Korean population. During the KNHANES VII and VIII, in addition to the ophthalmic questionnaire, intraocular pressure measurement, visual field test, auto refractometry, axial length and optical coherence tomography measurements were included. This new survey will provide not only provide normative and pathologic ophthalmic data including intraocular pressure, refractive error, axial length, visual field and precise measurement of anterior segment, macula and optic nerve with optical coherence tomography, but also a more accurate diagnosis for major adult blindness diseases, including age-related macular degeneration, diabetic retinopathy, glaucoma, and other ocular diseases, for the national Korean population.

Clinical Efficacy of Portable Electroretinograms

Purpose@#To compare electroretinogram (ERG) waveforms acquired using a portable flash/flicker ERG with skin electrodes (RETevalTM; LKC Technologies, Gaithersburg, MD, USA), a portable flash/flicker ERG with ERG-jet contact lens electrodes (Fabrinal SA, La Chaux-De-Fonds, Swiss), and a conventional full-field (Ganzfeld) ERG. @*Methods@#The left eyes of 30 volunteers with no general or ocular history were measured with a portable RETeval ERG, a portable ERG-jet system, and a conventional full-field ERG. Amplitudes and implicit times were compared among the measurements obtained using the three systems. @*Results@#The RETeval ERG generally showed a lower amplitude than that obtained using a conventional full-field ERG (all, p 0.1). @*Conclusions@#Given the differences in the readings from those obtained using a conventional full-field ERG, data from the portable ERG-RETeval type should be analyzed with caution. Notably, the portable ERG-jet showed no differences in its readings compared to those obtained using a conventional full-field ERG.

Methodology and Rationale for Ophthalmic Examinations in the Seventh and Eighth Korea National Health and Nutrition Examination Surveys (2017–2021)

This report provides a detailed description of the methodology for ophthalmic examinations according to the Korea National Health and Nutrition Examination Survey (KNHANES) VII and VIII (from 2017 to 2021). The KNHANES is a nationwide survey which has been performed since 1998 in representatives of whole Korean population. During the KNHANES VII and VIII, in addition to the ophthalmic questionnaire, intraocular pressure measurement, visual field test, auto refractometry, axial length and optical coherence tomography measurements were included. This new survey will provide not only provide normative and pathologic ophthalmic data including intraocular pressure, refractive error, axial length, visual field and precise measurement of anterior segment, macula and optic nerve with optical coherence tomography, but also a more accurate diagnosis for major adult blindness diseases, including age-related macular degeneration, diabetic retinopathy, glaucoma, and other ocular diseases, for the national Korean population.

Clinical Efficacy of Portable Electroretinograms

Purpose@#To compare electroretinogram (ERG) waveforms acquired using a portable flash/flicker ERG with skin electrodes (RETevalTM; LKC Technologies, Gaithersburg, MD, USA), a portable flash/flicker ERG with ERG-jet contact lens electrodes (Fabrinal SA, La Chaux-De-Fonds, Swiss), and a conventional full-field (Ganzfeld) ERG. @*Methods@#The left eyes of 30 volunteers with no general or ocular history were measured with a portable RETeval ERG, a portable ERG-jet system, and a conventional full-field ERG. Amplitudes and implicit times were compared among the measurements obtained using the three systems. @*Results@#The RETeval ERG generally showed a lower amplitude than that obtained using a conventional full-field ERG (all, p 0.1). @*Conclusions@#Given the differences in the readings from those obtained using a conventional full-field ERG, data from the portable ERG-RETeval type should be analyzed with caution. Notably, the portable ERG-jet showed no differences in its readings compared to those obtained using a conventional full-field ERG.

Comparison of Visual Acuity and Retinal Thickness According to Membranectomy in Idiopathic Epiretinal Membrane

PURPOSE: To compare the visual acuity and retinal thickness in patients with an idiopathic epiretinal membrane (ERM) after vitrectomy and membranectomy using two different methods.METHODS: This retrospective observational study included 77 eyes (32 eyes in the diamond-dusted membrane scraper [DDMS] group, and 45 eyes in the intraocular forceps [IOF] group) of 77 patients with idiopathic ERM who underwent pars plana vitrectomy and membranectomy. The main outcome measures were best-corrected visual acuity (BCVA, logMAR) and mean retinal thickness.RESULTS: In the IOF group, the BCVA at postoperative 1 week was significantly lower than at baseline and had improved at 12 weeks after surgery. In the DDMS group, the BCVA at postoperative 1 week showed no significant difference at baseline and had improved at 4 weeks after surgery. The central macular thickness at postoperative 6 months was significantly lower than at baseline (all, p < 0.001); there was no significant difference between the two groups (p = 0.400). The postoperative macular thickness of the DDMS group was significantly lower than that of the IOF group in the inner inferior and outer inferior areas at postoperative 12 weeks and 4 weeks (p = 0.046 and p = 0.039, respectively). Five eyes of the DDMS group and 15 eyes of the IOF group developed cystoid macular edema, 14 eyes of that improved without treatment.CONCLUSIONS: In patients with ERM, the use of DDMS or IOF for vitrectomy and membranectomy both resulted in improved visual acuity and decreased mean retinal thicknesses.

Utilizing a Previous Silicone Band Track in Recurred Retinal Detachment

PURPOSE: We report a case of utilizing a previous silicone band track in the reoperation of scleral encircling. CASE SUMMARY: An 8-year-old male presented with rhegmatogenous retinal detachment in the right eye. Five days after this diagnosis, he received scleral buckling surgery and cryopexy to seal the retinal tear. One month after surgery, a fundus examination showed subretinal fluid at the inferior site of the scleral buckle. He underwent scleral encircling surgery and a cryopexy procedure. The patient has had an uneventful postoperative course, and the retina has remained attached over a follow-up period of 9 months. However, exotropia and hypotropia developed in the right eye. Diagnosis of restrictive strabismus due to tissue adhesion around the silicone band was made. The encircling band was therefore removed and laser photocoagulation was performed 360° around the retina. Twenty-four hours after surgery, a fundus examination showed subretinal fluid. He received 360° scleral encircling surgery not using the 360° conjunctival peritomy. After confirming a previous encircling tract using #0-0 polydioxanone as a guide, #5-0 Nylon was tied to the end of the guide and inserted through the encircling tract with the end sutured with the silicone band. The silicone band was inserted into the encircling tract by pulling the #5-0 Nylon as a guide. Ophthalmoscopy revealed an attached retina with indentation of the scleral buckle at 360°. CONCLUSIONS: For reoperation in patients who previously underwent scleral encircling surgery, using the previous scleral encircling tract may be effective in cases with conjunctival and tissue adhesion.

A Case of Choroidal Osteoma with Subretinal Hemorrhage Improved by Intravitreal Bevacizumab and Aflibercept Injections

PURPOSE: To report a case of choroidal osteoma (CO) complicated by extensive subretinal hemorrhage treated with intravitreal bevacizumab and aflibercept injections. CASE SUMMARY: A 42-year-old female patient presented with decreased visual acuity and a temporal visual field defect in the left eye. The patient had a history of retinal hemorrhage in the left eye 3 years prior, which improved without any treatment. The patient's visual acuity had decreased to 0.6 at the initial visit. On fundus examination, orange-colored elevated lesions involving the superior peripapillary area with massive subretinal hemorrhage extending to the macular area were revealed. Optical coherence tomography, fluorescein angiography, and B-scan ultrasonography results indicated CO complicated by choroidal neovascularization (CNV). With multiple intravitreal injections of bevacizumab and aflibercept (bevacizumab ×1, aflibercept ×2), the patient's visual acuity improved and the CNV lesion was kept stable without recurrence as of the 1-year follow-up visit. CONCLUSIONS: Intravitreal bevacizumab and aflibercept injections can be helpful in the treatment of CO complicated by CNV, by improving visual acuity and the retinal anatomy.

A Case Report of Central Retinal Artery Occlusion Caused by Cardiac Myxoma

PURPOSE: We report the case of a patient diagnosed with central retinal artery occlusion caused by cardiac myxoma who underwent surgery to remove the myxoma. CASE SUMMARY: A 47-year-old woman came to our clinic presenting with a sudden decrease of visual acuity in the left eye. At the first visit, left eye visual acuity was hand motion, and intraocular pressure was 15.4 mmHg. A relative afferent pupillary defect was observed in the left eye. On fundus examination, a pale retina and cherry-red spot were observed at the posterior pole. On optical coherence tomography, macular edema was found. On fluorescein angiography and indocyanine green angiography, delayed blood circulation of the retina and choroid was found at early and late stages. Cerebral angiography was performed in the neurosurgery department and showed no occlusion of the ophthalmic artery. Cardiac ultrasonography and brain magnetic resonance imaging were performed. On cardiac ultrasonography, 4.46 × 2.09 cm cardiac myxoma was found. Resection of the cardiac myxoma was conducted in the thoracic and cardiovascular surgery department. Multiple cerebral infarcts were detected by brain imaging, and antithrombotic treatment was administered. After one month, blood circulation in the retina and choroid was observed in fluorescence angiography, but there was no improvement of visual acuity. At the 3-month follow-up visit, macular edema was decreased, but retinal atrophy and epiretinal membrane were observed on optical coherence tomography. CONCLUSIONS: Central retinal artery occlusion is a disease related to one's general condition. We experienced this case of central retinal artery occlusion caused by cardiac myxoma.

Arcuate Retinal Nerve Fiber Swelling after Internal Limiting Membrane Peeling

PURPOSE: To evaluate the cause of dark arcuate striae observed in infrared photographs in idiopathic epiretinal membrane (ERM) and macular hole patients after internal limiting membrane (ILM) peeling. METHODS: Forty patients (41 eyes) of idiopathic ERM and macular hole who underwent trans pars plana vitrectomy with ILM peeling and gas tamponade were included in the present study. The best corrected visual acuity (BCVA) was recorded at preoperative and postoperative 6 months. Infrared (IR) photography with spectral domain optical coherence tomography (SD-OCT) were obtained at preoperative and postoperative 1 week, 1 month, 3 months, and 6 months. When abnormal findings were visible on IR photographs, additional SD-OCT was performed at the corresponding sites. RESULTS: Of 40 patients, 4 patients demonstrated dark striae extending from the optic nerve to near macular area in IR photographs at 1 week postoperatively. SD-OCT images of the dark striae region revealed the swelling of retinal nerve fiber layer (RNFL). At postoperative 6 months, however, RNFL swelling previously observed subsided in all 4 cases, while temporal retinal thinning and dimples were observed in 3 cases. The preoperative and postoperative BCVA did not show any statistical difference between the patients with the RNFL swelling and the patients without the swelling. CONCLUSIONS: Swelling of RNFL may occur in idiopathic ERM and macular hole patients after pars plana vitrectomy and ILM peeling, which may present as dark striae in IR photographs.

Serum Concentration of Vascular Endothelial Growth Factor after Bilateral Intravitreal Injection of Bevacizumab

PURPOSE: This study compared serum vascular endothelial growth factor (VEGF) concentration between patients given the bilateral and unilateral intravitreal injections of bevacizumab. METHODS: In a prospective manner, serum VEGF levels in treatment-naive patients with age-related macular degeneration who underwent bilateral or unilateral intravitreal injections of bevacizumab were investigated. After informed consent, peripheral blood was collected from in patients who underwent bilateral or unilateral intravitreal injection of bevacizumab before and 1 month after the injection. Serum VEGF levels were measured by enzyme-linked immunosorbent assay after centrifugation. In addition, best-corrected visual acuity (BCVA) and central retinal thickness (CRT) before and 1 month after the injection were compared between each group. RESULTS: Twenty patients received bilateral injections (40 eyes) and 20 patients received unilateral injections. The VEGF concentrations (pg/mL) before the bilateral injection were 235.75 +/- 183.16 and 252.53 +/- 233.52 for the unilateral injection. They were significantly reduced to 153.88 +/- 113.26 and 189.42 +/- 251.72 after 1 month, respectively (p = 0.037 and 0.019), which are showing no significant difference between the two groups (p = 0.771). And there were no significant intergroup difference in pre- and postoperative BCVA and CRT. CONCLUSIONS: The bilateral simultaneous intravitreal injection of bevacizumab did not differ greatly from unilateral intravitreal injection in the influence on serum VEGF levels and the therapeutic outcome.

Serum Concentration of Vascular Endothelial Growth Factor after Bilateral Intravitreal Injection of Bevacizumab

PURPOSE: This study compared serum vascular endothelial growth factor (VEGF) concentration between patients given the bilateral and unilateral intravitreal injections of bevacizumab. METHODS: In a prospective manner, serum VEGF levels in treatment-naive patients with age-related macular degeneration who underwent bilateral or unilateral intravitreal injections of bevacizumab were investigated. After informed consent, peripheral blood was collected from in patients who underwent bilateral or unilateral intravitreal injection of bevacizumab before and 1 month after the injection. Serum VEGF levels were measured by enzyme-linked immunosorbent assay after centrifugation. In addition, best-corrected visual acuity (BCVA) and central retinal thickness (CRT) before and 1 month after the injection were compared between each group. RESULTS: Twenty patients received bilateral injections (40 eyes) and 20 patients received unilateral injections. The VEGF concentrations (pg/mL) before the bilateral injection were 235.75 +/- 183.16 and 252.53 +/- 233.52 for the unilateral injection. They were significantly reduced to 153.88 +/- 113.26 and 189.42 +/- 251.72 after 1 month, respectively (p = 0.037 and 0.019), which are showing no significant difference between the two groups (p = 0.771). And there were no significant intergroup difference in pre- and postoperative BCVA and CRT. CONCLUSIONS: The bilateral simultaneous intravitreal injection of bevacizumab did not differ greatly from unilateral intravitreal injection in the influence on serum VEGF levels and the therapeutic outcome.

Acute Ocular Manifestations after an Accidental Hydrofluoric Acid Release

PURPOSE: To report the ocular health of a community after an accidental release of hydrofluoric acid (HF). METHODS: The hospital records of 327 patients that were exposed to HF between Sep 9, 2012 and Oct 31, 2012 were reviewed. Demographic characteristics, subjective ocular symptoms, and the ophthalmologic examination results of the patients were analyzed retrospectively. RESULTS: Among the 327 patients, 203 patients (62.1%) were exposed to hydrofluoric acid (HF) within 1,000 m of the site of the accident. A total of 131 patients (40.1%) were exposed to HF over 3 days. The most frequently reported ocular symptoms after HF exposure were ocular pain (49.5%) and conjunctival hyperemia (37.9%). Conjunctival hyperemia (43.4%), corneal erosion (23.9%), conjunctiva papilla, and follicles (24.2% and 14.4%, respectively) were noted during ophthalmologic examinations, but 46.2% of patients were normal on examination. None of the patients had vision-threatening damages. CONCLUSIONS: In this study, severe ocular surface changes, which can affect vision, were not identified. This result could be explained by the low atmospheric HF concentration after the accident.

Postural Effect on Intraocular Pressure in Gas-Filled Eyes after Vitrectomy

PURPOSE: To assess the influence of body position on intraocular pressure (IOP) in patients who underwent vitrectomy and intraocular gas tamponade. METHODS: Patients who did not undergo any surgery were defined as Group 1. The remaining patients were divided into 3 groups according to the surgery performed (Group 2; cataract surgery, Group 3; vitrectomy and cataract surgery, Group 4; vitrectomy with intraocular gas tamponade and cataract surgery). IOP was measured by a non-contact tonometer, Goldmann applanation tonometer, and Tono-Pen in the sitting, supine, and prone positions. RESULTS: The difference of IOP measured in the sitting position among the 4 groups was not significant. IOP was significantly elevated by 2.04 mm Hg on average when the posture was changed from sitting to supine or prone in all 4 groups. The IOP discrepancy between supine and sitting positions was significantly greater in group 4 by 3.61 mm Hg than the other groups (p = 0.003, ANOVA test). The IOP difference between the prone and sitting position was also significantly higher in group 4 by 3.82 mm Hg than the other groups (p = 0.001, ANOVA test). CONCLUSIONS: The patients with vitrectomized gas tamponade eyes had a mean IOP increase of 3.82 mm Hg when the position was changed from sitting to prone. When performing vitrectomy and intraocular gas tamponade on patients in the prone position, an IOP elevation should be monitored thoroughly.

Rapidly Progressive Endogenous Endophthalmitis with Subretinal Abscess

PURPOSE: To report a case of a rapidly progressive endogenous endophthalmitis with subretinal abscess that involved the macula and was treated with early vitrectomy. CASE SUMMARY: A 42-year-old man with liver cirrhosis, hepatic cellular carcinoma and diabetes, who underwent regular fundus checkup for diabetic retinopathy presented with reduced vision, ocular pain in the left eye and headache. Indirect ophthalmoscopy showed subretinal abscess approximately five times the optic disc size and surrounding retinal hemorrhage in the nasal upper quadrant. A provisional diagnosis of bacterial endophthalmitis was made based on systemic disease and funduscopic findings. Treatment with topical and systemic empirical antibiotics was initiated along with intravitreal vancomycin and ceftazidime injection. Despite the treatment, after 24 hours the abscess size increased to approximately 10 times the optic disc size and began to involve the macula. The patient underwent diagnostic and therapeutic pars plana vitrectomy as well as vitreous and abscess content cultures. MRSA was found in a blood culture test. Five days postoperatively, the patient's vision and symptoms improved significantly and the residual lesion was cleared, with retinal scars. CONCLUSIONS: In a patient with endogenous endophthalmitis with subretinal abscess, presence of macular invasion and rate of progression is important in determining the time and method of operation. In this case, early vitrectomy was a good choice to preserve macular structure and the patient's visual acuity.

Clinical Features According to the Occlusion Site in Patients with Branch Retinal Vein Occlusion

PURPOSE: To evaluate clinical patterns according to the occlusion site in patients with branch retinal vein occlusion. METHODS: Ninety-one branch retinal vein occlusion patients were divided into 4 groups according to the occlusion site based on the description by Duke-Elder and Wybar: Papillary retinal vein occlusion group (group A), main retinal vein occlusion group (group B), minor retinal vein occlusion group (group C), and retinal venule occlusion group (group D). The following factors were analyzed retrospectively: baseline/final visual acuity, visual improvement, macular thickness, and macular circulatory states. RESULTS: The macular thickness (microm) was 575.33 +/- 178.44 in group A, 511.92 +/- 218.02 in group B, 397.21 +/- 144.51 in group C, and 336.68 +/- 120.55 in group D. The retinal ischemic area (DD) was 22.00 +/- 13.28 in group A, 18.26 +/- 10.12 in group B, 12.52 +/- 10.52 in group C, and 12.36 +/- 11.92 in group D, which was found to be significantly greater in the group with the higher branch occlusion site (p < 0.05). However, visual acuity, macular circulatory states and other clinical characteristics were not significantly different. CONCLUSIONS: Occlusion site is a relating factor for retinal ischemic area and macular thickness in patients with Branch retinal vein occlussion, but which is not a prognostic factor for final visual acuity.

Intravitreal Bevacizumab Injection in Diabetic Papillopathy

PURPOSE: To report a case where intravitreal bevacizumab injection was an effective treatment for diabetic papillopathy in a type 2 diabetic patient. CASE SUMMARY: A 47-year-old male with a 10-year history of diabetes mellitus type 2 presented to our clinic for evaluation of diabetic retinopathy. There were no subjective symptoms including blurred vision or visual defect, and best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/30 in the left eye. Fundus examination showed hyperemic optic disc swelling with telangiectatic new vessels, and fluorescein angiography leakage from the optic disc with neovascularization. The patient underwent fractionated panretinal photocoagulation. Ten days later, he complained of painless blurred vision with significant optic nerve head swelling and BCVA was 20/80 in the left eye. Intravitreal bevacizumab injection was administered, optic disc swelling was significantly decreased and BCVA improved to 20/30 after two months. CONCLUSIONS: Diabetic papillopathy with severe decreased visual acuity can be treated with intravitreal bevacizumab injection.

Clinical Usefulness of Binocular Multifocal Electroretinography in Patients with Monocular Macular Disease

PURPOSE: To evaluate the clinical usefulness of binocular multifocal electroretinography (mfERG) by comparing results with conventional monocular mfERG in patients with monocular macular disease. METHODS: mfERG testing was conducted on 32 patients with monocular macular disease and 30 normal subjects. An initial mfERG was simultaneously recorded from both eyes with two recording electrodes under binocular stimulation. A second mfERG was subsequently recorded with conventional monocular stimulation. Amplitudes and implicit times of each ring response of the binocular and monocular recordings were compared. Ring ratios of the binocular and monocular recording were also compared. RESULTS: In the macular disease group, there were no statistical differences in amplitude or implicit time for each of the five concentric rings between the monocular and binocular recordings. However, with binocular simulation, the ring ratios (ring 1 / ring 4, ring 1 / ring 5) were significantly reduced in the affected eye. In the normal control group, there were no statistical differences in any parameters between the monocular and binocular recordings. CONCLUSIONS: Binocular mfERG could be a good alternative to the conventional monocular test. In addition, given that the test needs stable fixation of the affected eye during the binocular test, the reliability of the test results could be improved, especially for patients with monocular macular disease.