Normative data for macular perimetry using the MP-3 microperimeter in healthy individuals / Dados normativos para perimetria macular usando o microperímetro MP-3 em indivíduos normais

ABSTRACT Purpose: Microperimetry has been used for several years as a form of visual function testing in patients with retinal diseases. Normal microperimetry values obtained with microperimeter MP-3 have not yet been fully published, and baseline values for topographic macular sensitivity and correlations with age and sex are needed to establish degrees of impairment. This study aimed to determine values for light sensitivity thresholds and fixation stability using the MP-3 in healthy individuals. Methods: Thirty-seven healthy volunteers (age, 28-68 years), underwent full-threshold microperimetry using a 4-2 (fast) staircase strategy with the standard Goldmann III stimulus size and 68 test points positioned identically to those in the Humphrey Field Analyzer 10-2 test grid. The fixation stability was simultaneously recorded during the microperimetry test. The relationship between global sensitivity and age was calculated using linear regression analysis. Results: Microperimetry was performed on 37 participants (74 eyes). The global mean sensitivity was 29.01 ± 1.44 (range, 26-31) dB. The mean central sensitivity at 2° measured by the MP-3 was 28.5 ± 1.77 dB in the right eye (OD) and 28.75 ± 1.98 dB in the left eye (OS). The total median fixation stability values within 2° and 4° were 80% and 96%, respectively. The linear regression analysis also revealed an age-related global sensitivity decline per year of -0.051 dB ± 0.018 (OD) and -0.078 dB ± 0.021 (OS). Conclusions: Microperimetry performed with the MP-3 allows for an automatic, accurate, and topography-specific examination of retinal sensitivity thresholds. The results of this study provide a normal and age-matched database of MP-3 microperimetry.

RESUMO Objetivos: A microperimetria tem sido usada há vários anos como uma forma de teste de função visual em pacientes com doenças da retina. Os valores normais de microperimetria obtidos com MP-3 ainda não foram totalmente publicados e os valores basais para sensibilidade macular topográfica e correlações com idade e sexo são necessários para estabelecer graus de comprometimento. O objetivo do trabalho é determinar valores para limiares de sensibilidade à luz e estabilidade de fixação usando o MP-3 em indivíduos normais. Métodos: Trinta e sete voluntários saudáveis (idade: 28-68 anos), submetidos à microperimetria de limiar total usando uma estratégia de escada 4-2 (rápida) com o tamanho de estímulo padrão Goldmann III e 68 pontos de teste posicionados de forma idêntica aos do Humphrey Field Analyzer 10-2 grade de teste. A estabilidade da fixação foi registrada simultaneamente durante o teste de microperimetria. A relação entre a sensibilidade global e a idade foi calculada por meio de análise de regressão linear. Resultados: A microperimetria foi realizada em 37 indivíduos (74 olhos). A sensibilidade média global foi de 29,01 ± 1,44 dB, intervalo: 26-31 dB. A mediana da sensibilidade central a 2° medida pelo MP-3 foi de 28,5 ± 1,77 dB (ER) e 28,75 ± 1,98 dB (OE). Os valores médios totais de estabilidade da fixação em 2° e 4° foram 80% e 96%, respectivamente. A análise de regressão linear também revelou um declínio de sensibilidade global relacionado à idade por ano de -0,051 dB ± 0,018 (ER) e -0,078 dB ± 0,021 (LE). Conclusões: A microperimetria realizada com o MP-3 permite um exame automático, preciso e específico da topografia dos limiares de sensibilidade da retina. Os resultados deste estudo fornecem um banco de dados normal e de idade correspondente da microperimetria MP-3.

Progress in imaging and functional assessment of myopic fundus tessellation changes / 国际眼科杂志(Guoji Yanke Zazhi)

Myopia has become a serious global burden of visual impairment and blindness, and the World Health Organization has included the prevention and treatment of myopia in its global blindness prevention program. Many ocular pathological alterations that follow from advanced myopia could cause visual impairment and even blindness in severe situations. Myopia is becoming more prevalent and has a greater impact on young people. Myopia's social repercussions are becoming more widely known. One of the several fundus alterations linked to myopia is tessellated fundus, which is the earliest lesion in the natural course of myopic fundus lesions and an important clinical marker for the development of retinopathy. Currently, there are several different methods of grading fundus tessellation, all of which are graded subjectively by fundus color photography. One can investigate the morphological characteristics and functional status of the tessellated fundus with ophthalmoscope, fundus photography, optical coherence tomography, electroretinogram, microperimetry and other modal images. In this study, the imaging properties and common applications of the tessellated fundus are reviewed to provide appropriate resources for clinical ophthalmology.

Correlation between macular mean sensitivity and ganglionic plexiform layer in non-arteriotic anterior ischemic optic neuropathy / 中华眼底病杂志

Objective:To observe and analyze the changes and correlation of macular mean sensitivity (MS) and the thickness of ganglionic plexiform layer (GCIPL) in patients with non-arteriotic anterior ischemic optic neuropathy (NAION).Methods:A cross-sectional clinical study. From March to August 2023, 37 patients with 38 eyes of NAION (NAION group) diagnosed by ophthalmic examination in the First Affiliated Hospital of Zhengzhou University were included in the study. In the NAION group, 29 patients with contralateral healthy eyes were selected as the contralateral healthy eye group. A total of 31 eyes of 16 healthy subjects matching gender and age were selected as the normal control group. NAION group was divided into acute stage group (disease course ≤3 weeks), subacute stage group (disease course 4-12 weeks) and chronic stage group (disease course>12 weeks), with 16, 10 and 12 eyes, respectively. Best corrected visual acuity (BCVA), optical coherence tomography (OCT), perimetry, and microperimetry were performed. BCVA statistics are converted to logarithm of the minimum angle of resolution (logMAR). The macular region was scanned by Cirrus HD-OCT macular volume 512×128 scanning program. The mean (GCIPLav), minimum (GCIPLmin), and the GCIPL thickness at supranasal, superior, subnasal, supratemporal, inferior, and inferotemporal quadrants were detected. The Humphrey 24-2 automated visual field test was utilized to measure the mean defect (MD) of the visual field. MP-3 microperimetry was used to measure MS (total MS) in the 10° macular region and MS in the supranasal, superior, subnasal, supratemporal, inferior, and inferotemporal quadrants. MS> 21 dB was defined as normal. One-way analysis of variance was used to compare among groups. t test was used to compare GCIPL thickness between MS≤21 dB and> 21 dB regions. Spearman correlation analysis was used to analyze the correlation between GCIPL thickness and MS in corresponding areas. Results:There were statistically significant differences in logMAR BCVA and MS in the NAION group, contralateral healthy eye group, and normal control group ( F=13.595, 83.741; P<0.05). GCIPL thickness in the MS≤21 dB region was significantly lower than that in the> 21 dB region in the NAION group ( t=2.634, P=0.009). The thickness of GCIPL in the inferotemporal quadrant decreased in the NAION group compared with the contralateral healthy eye group and normal control group, but the difference was not statistically significant ( P=0.092, 0.192). The thickness differences of GCIPLav and GCIPLmin and GCIPL in other quadrants were statistically significant ( P<0.05). Compared with the contralateral healthy eye group and normal control group, the thickness of GCIPLmin, superior and supratemporal of GCIPL in the acute stage group were significantly decreased ( P<0.05). The thickness of GCIPLav, GCIPLmin, GCIPL in upranasal, superior and supratemporal quadrants were significantly decreased in the subacute stage group ( P<0.05). The thickness of GCIPLav, GCIPLmin and GCIPL in all quadrants were significantly decreased in the chronic stage group ( P<0.05). Correlation analysis showed that total MS were significantly correlated with logMAR BCVA ( r=0.779, -0.596, P<0.001) in NAION group. The inferior GCIPL thickness was significantly correlated with MS in the corresponding region ( r=0.410, P=0.046), while no correlation was found in the other quadrants ( r=0.220, 0.148, -0.131, 0.296, 0.321; P>0.05) in NAION group. GCIPL thickness in acute and subacute groups was significantly correlated with MS ( r=0.329, 0.400; P=0.007, 0.028). There was no correlation in the chronic phase group ( r=0.238, P=0.103). Conclusions:GCIPL atrophy and thinning and MS decrease in the macular area of NAION. The thickness of GCIPL in the MS decreasing region is significantly lower than that in the MS normal region. GCIPL atrophy and thinning in acute and subacute stages are correlated with MS.

Preliminary observation of the effect of cystic cavity on visual function of macular area before and after operation in idiopathic macular hole / 中华眼底病杂志

Objective:To observe and analyze the effect of peripore cavity size on visual function of macular area before and after surgery for idiopathic macular hole (IMH).Methods:A retrospective clinical study. From July 2020 to February 2021, a total of 25 patients with 25 eyes with monocular IMH (operation group) diagnosed by ophthalmology examination in Department of ophthalmology, Fourth Hospital of Hebei Medical University were included in the study. The control group was contralateral healthy eyes. All subjects were examined by best corrected visual acuity (BCVA), microfield of vision, frequency domain optical coherence tomography (SD-OCT), and OCT angiography (OCTA). The diameter of macular hole was measured by SD-OCT. The cystic morphology of deep capillary plexus (DCP) was detected by en face OCT, and the cystic area was measured by Image J software. MP-3 microperimeter was used to measure central macular retinal light sensitivity (MS) and mean macular retinal light sensitivity (MMS). Central macular retinal light sensitivity (CMS), MMS and cystic cavity MS were measured in the operation group. MMS was measured in the control group. The microperimetry images were superimposed on the DCP layer of OCTA to identify and calculate the average MS within the lumen and compare it with the control group. Standard three incisions were performed in all affected eyes by vitrectomy of the flat part of the ciliary body + stripping of the inner boundary membrane + intraocular sterile air filling. Three months after the operation, the same equipment and methods were used to perform relevant examinations. Paired sample t test was used to compare MS between operation group and control group. Pearson correlation analysis was used to analyze the correlation between capsular area, macular hole diameter before and after operation and MS before and after operation. The correlation between BCVA and capsular area before and after surgery was analyzed by Spearman correlation analysis. Results:In the surgical group, the retinal MS was (4.24±3.07) dB. The MMS of control group was (19.08±6.11) dB. The MS in the surgical group was significantly lower than that in the control group, and the difference was statistically significant ( t=10.832, P<0.01). Before operation, the area of cyst was (1.04±0.55) mm 2, and the diameter of macular hole was (564.80±166.59) μm. CMS and MMS were (2.27±2.29) dB and (9.08±3.65) dB, respectively. The diameter of macular hole ( r=0.50, P=0.010) and BCVA before operation ( r=0.57, P<0.001) were positively correlated with peripore cavity area. Before operation, CMS and MMS were negatively correlated with peripore cavity area ( r=-0.53, -0.47; P=0.010, 0.020). At 3 months after surgery, the capsular area was negatively correlated with CMS and MMS ( r=-0.65,-0.76; P=0.020, 0.030). There was no correlation with BCVA ( r=0.23, P=0.470). Conclusions:Retinal MS is decreased in the peri-capsular area of IMH pore. There is a positive correlation between capsule area, BCVA and macular hole diameter before operation. The capsular area is negatively correlated with CMS and MMS before operation.

Evaluation of macular function changes in glaucoma using MAIA microperimetry / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe the characteristics of microperimetry in patients with glaucoma, and investigate the correlation between microperimetry and best corrected visual acuity(BCVA), standard automatic perimetry and optical coherence tomography(OCT)index.METHODS: This case-control study included 45 patients(76 eyes)with glaucoma(glaucoma group), among which 15 patients(25 eyes)with primary open-angle glaucoma and 30 patients(51 eyes)with chronic angle-closure glaucoma, and 40 healthy individuals(76 eyes)were included in the control group. MAIA microperimetry, Humphrey perimetry, and BCVA tests were performed in all examined eyes. Correlation analysis was performed using the structural indices measured by OCT.RESULTS: The mean sensitivity(MS)in macular area measured by microperimetry and the ganglion cell complex(GCC)and retinal nerve fiber layer(RNFL)thickness measured by OCT were decreased in glaucoma patients when compared to the control group. Additionally, the mean defect(MD)measured by Humphrey perimetry(10-2 visual field test), focal loss volume(FLV), global loss volume(GLV)measured by OCT, and 63% bivariate contour ellipse area(BCEA )measured by MAIA microperimetry were higher than those of the control group. The MS was negatively correlated with MD, FLV, GLV and BCVA(LogMAR)in the glaucoma group(rs=-0.839, -0.665, -0.530, and -0.424, all P&#x003C;0.01). In contrast, MS was positively correlated with GCC and RNFL in the glaucoma group(rs=0.437, 0.500, all P&#x003C;0.01). MAIA microperimetry had a shorter detection time. Receiver operating characteristic(ROC)curve analysis showed that MAIA microperimetry had moderate accuracy for the diagnosis of glaucoma.CONCLUSIONS: MAIA microperimetry has high sensitivity and can detect retinal sensitivity reduction in areas of structural damage tested by OCT. The microperimetry values were correlated with BCVA, standard automatic perimetry parameters, and OCT parameters. MAIA microperimetry combined with OCT will increase the early diagnosis rate of glaucoma.

Application of OCTA combined with microperimetry in macular edema secondary to retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To quantitatively evaluate the macular microvasculature and visual function in patients with macular edema secondary to retinal vein occlusion(RVO)by optical coherence tomography angiography(OCTA)combined with microperimetry. <p>METHODS: Totally 36 patients(36 eyes)with monocular RVO complicated with macular edema were enrolled, including 15 patients(15 eyes)in central retinal vein occlusion(CRVO)group and 21 patients(21 eyes)in branch retinal vein occlusion(BRVO)group(all with superior temporal vein occlusion), 15 age-matched healthy subjects(24 eyes)were included as controls. OCTA was used to scan macular retina in the range of 3mm×3mm in all three groups and measure the vascular density(VD)of superficial capillary plexus(SCP)and deep capillary plexus(DCP), the area of foveal avascular zone(FAZ)and the central retinal thicknes(CRT); the retinal mean sensitivity(RMS)at 10°was measured by MP-3 microperimetry. VD and RMS in BRVO group were further divided into lesion area(superior), non-lesion area(inferior)VD and RMS. The lesion area and non-lesion area of the control group were divided according to corresponding regions of the BRVO group. The changes of above indexes in CRVO group and BRVO group were compared with control group respectively, and the correlation between RMS and VD, CRT and FAZ areas in CRVO group and BRVO group was analyzed.<p>RESULTS:The overall VD(SCP and DCP)in CRVO group were lower than those in control group(<i>t</i>= -2.536, <i>P</i>=0.016; <i>t</i>= -8.834, <i>P</i><0.001); the area of FAZ was larger than that in control group(<i>t</i>=3.354, <i>P</i>=0.002); the CRT was thicker than that in control group(<i>t</i>=13.888, <i>P</i><0.001); the overall RMS was significantly lower than that in control group(<i>t</i>= -6.250, <i>P</i><0.001). The overall VD(SCP and DCP)in BRVO group were decreased compared to those in control group(<i>t</i>= -5.186, <i>P</i><0.001; <i>t</i>= -5.238, <i>P</i><0.001); the VD of SCP and DCP in the affected sector were decreased compared to those in the corresponding sector of the control group(<i>t</i>= -5.611, <i>P</i><0.001; <i>t</i>= -6.940, <i>P</i><0.001); the VD in the unaffected sector was significantly less than that in the corresponding sector of the control group only in DCP, but not in SCP(<i>t</i>= -3.047, <i>P</i>=0.004; <i>t</i>= -1.459, <i>P</i>=0.156); the area of FAZ was larger than that in control group(<i>t</i>=2.722, <i>P</i>=0.011); the CRT was thicker than that in control group(<i>t</i>=7.764, <i>P</i><0.001); the overall RMS was significantly lower than that in control group(<i>t</i>= -10.931, <i>P</i><0.001); the RMS in both the affected sector and the unaffected sector were lower than those in the corresponding sector of the control group(<i>t</i>= -13.183, <i>P</i><0.001; <i>t</i>= -8.074, <i>P</i><0.001). In CRVO group,the overall VD of SCP and DCP was positively correlated with the overall RMS(<i>r</i>=0.571, <i>P</i>=0.026; <i>r</i>=0.813, <i>P</i><0.001)and the area of FAZ and CRT was negatively correlated with the overall RMS(<i>r</i>= -0.621, <i>P</i>=0.014; <i>r</i>= -0.533, <i>P</i>=0.041). In BRVO group,the overall VD of SCP and DCP was positively correlated with the overall RMS(<i>r</i>=0.465, <i>P</i>=0.034; <i>r</i>=0.611, <i>P</i>=0.003), and the CRT was negatively correlated with the overall RMS(<i>r</i>= -0.547, <i>P</i>=0.01), while there was no correlation between the area of FAZ and the overall RMS(<i>r</i>= -0.421, <i>P</i>=0.057).<p>CONCLUSION: The combined application of OCTA and microperimetry can corresponding quantitatively evaluate the structure and function of macular area in patients with macular edema secondary to retinal vein occlusion, providing more detailed information for clinical decision makers to explain the disease well.

The correlation between visual acuity and microperimetry evaluation of macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the correlation between subjective mean sensitivity and visual function <i>via</i> macular microperimetry.<p>METHODS: Totally 164 eyes of 127 patients with macular edema were involved in this study. According to different diseases, they were divided into 3 groups: age-related macular degeneration(AMD)(38 eyes), retinal vein occlusion(RVO)(43 eyes)and diabetic macular edema(83 eyes)groops. All patients underwent the examinations of optometry, optical coherence tomography scanner(OCT)and microperimeter. Correlation analysis was performed using Pearson, and <i>t</i>-test among groups.<p>RESULTS: Mean sensitivity(MS)values and fixation rate(P1, P2)of total patients with macular edema were significantly correlated with their BCVA, meanwhile the CRT was negatively correlated. MS values were significantly correlated with BCVA in AMD group, but the P1, P2 and CRT were not correlated. In DME and CRVO groups, MS values and P1, P2 were significantly correlated with BCVA, and CRTs were negatively correlated in DME but not correlated in CRVO. In BRVO group, MS values and CRTs were all not correlated with BCVA.<p>CONCLUSION:Microperimetry is probably a better subjective assessment for AMD macular function than OCT, and could be combined with OCT for function follow-up in DME and CRVO patients. For BRVO microperimetry might indicate certain macular dysfunction that could not be detected by VA or CCT. Microperimetry could be a subjective examination for the assessment of macular edema combined with OCT.

Preliminary research of Xiaozhong decoction combined with Conbercept on visual function of diabetic macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To preliminary evaluate retinal sensitivity and the fixation alterations in patients with diabetic macular edema(DME)under Xiaozhong decoction combined intravitreal conbercept therapy. <p>METHODS: The 40 patients with DME were randomly divided into two groups. Treatment group: 20 patients(20 eyes), Xiaozhong decoction combined with conbercept group and treatment group; 20 patients(20 eyes), placebo combined with conbercept group in our hospital from January to October in 2017. The two groups were taken oral Chinese medicinals or placebo for 3mo respectively. BCVA(ETDRS visual acuity test)and CRT(OCT)of the two groups were observed, and the retinal sensitivity and fixation stability(P1, P2)were measured by MAIA microperimetry.<p>RESULTS: After 3mo of treatment, BCVA of treatment group and control group increased by 4(-1, 11.5)and 0(-4, 0.75)letters compared with baseline(<i>P</i><0.05), and CRT decreased by 123.5±42.61 and 18.1±12.84μm respectively(<i>P</i><0.05). The retinal sensitivity increased slightly after treatment in the two groups, but there was no significant difference between the two groups and over the course of treatment in control group(<i>P</i>>0.05). The sensitivity of retina in treatment group was the highest(20.11±4.98dB)at 2mo. P1 and P2 in the two groups increased significantly after treatment. The increase of P1 in the treatment group was significantly higher than that in the control group at 2mo(<i>P</i><0.05). But there was no difference in the increase of P2 between the two groups after treatment(<i>P</i>>0.05).<p>CONCLUSION: Intravitreal conbercept could improve the fixation stability in DME patients, combined with Xiaozhong decoction was conducive to maintain fixation stability.

Correlation of optical coherence tomography angiography and microperimetry (MP3) features in wet age-related macular degeneration

Purpose: To evaluate and correlate the functional treatment response using microperimetry (MP3) with the morphological findings on optical coherence tomography angiography (OCTA) in wet AMD pre- and post-treatment with anti-vascular endothelial growth factor (VEGF). This was a single-centre prospective, interventional study. Methods: Patients with wet AMD were treated with 3 injections of intravitreal anti-VEGF at monthly intervals for 3 months and followed at 1, 2, 3, and 6 months postinjection. Using “overlay” features, morphologic characteristics of OCTA at the site of choroidal neovascular membrane (CNVM) lesion were analyzed and correlated functionally with MP3. Data were collected including visual acuity at presentation and follow-up with multimodal imaging features, treatment details, complications (if any), and treatment given for that complication. Descriptive observational analysis and paired t-test was used to compare the appearance of the neovascular network on OCTA imaging with retinal sensitivity on MP3. Results: OCTA in the pretreatment phase revealed CNVM as an abnormal vascular network arising from the choroid and invading the subretinal space. On MP3, decreased retinal sensitivity was observed corresponding to the area of CNVM. Post-treatment, OCTA revealed reduction in abnormal vascular network in 51 (91.07%) eyes that correlated with increased retinal sensitivity at the corresponding area on MP3. Statistical analysis showed baseline mean retinal sensitivity at the site of CNVM as 320.07 dB, which improved to 521.53 and 730.20 dB at 1 and 3 months postinjection follow-up, respectively. Conclusion: Combining the findings of OCTA and MP3 using “overlay” features gives us precise information of structure–function correlation at presentation and also in response to treatment. It also helps to improve patient's compliance, confidence to treatment, and their understanding of the disease process as well.

Transposition of internal limiting membrane with a non - inverted flap technique for large macular hole / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM:To explore the effectiveness of a new non-inverted pedicle internal limiting membrane ( ILM ) flap transposition technique in the treatment of large macular holes (MH). ·METHODS: This was a prospective pilot study which included 9 patients with 10 eyes in Jiangsu Province People's Hospital from December 2016 to February 2017. All patients was diagnosed with large MH (size >400μ m) by the spectra- domain optical coherence tomography (SD-OCT) and underwent the non-inverted pedicle ILM flap transposition surgery. Best-corrected visual acuity (BCVA), SD-OCT images, and MP-1 microperimetry tests were performed pre-operation, 1d, 1wk, 1, 3, and 6mo post-operation. ·RESULTS:The macular hole closure rate after 6mo was 100%. The averaged BCVA improved from 1. 19 ± 0. 54 (LogMAR) pre-operation to 0.70 ± 0.50 (LogMAR) post-operation (P=0.005). The mean retinal sensitivity within 8° and 2° improved from 3.14±4.52dB to 8.91±5.53dB(P=0.008), and 1.46 ± 2.94dB to 6.33 ± 4.90dB (P=0.008) respectively. Preoperative unstable fixation in seven eyes resolved at the last postoperative follow-up.·CONCLUSION: Our non-inverted pedicle internal ILM flap transposition technique shows effectiveness in the treatment of large macular holes with high MH closure rate and improving visual function.

Assessment of microperimetry on fixation stability changes in glaucomatous eyes with hemifield defect / 中华实验眼科杂志

Background Researches showed that microperimetry can exhibit more tiny visual function damage than conventional perimetry in glaucomatous eyes.However,the study on fixation stability of glaucoma is still rare until now.Objective This study was to compare the correlation between microperimetry Maia (Macular Integrity Assessment) and Humphrey perimetry,and to investigate the changes of the fixation stability in glaucoma patients with hemifield defect.Methods This study proposal was approved by Medical Ethic Committee of Peking University First Hospital.A cross-sectional study was performed under the informed consent of each subject.Thirtyfive eyes of 35 glaucoma patients with hemifield defect by 24-2 Humphrey perimetry were included in Peking University First Hospital from December 2013 to March 2014,and 30 eyes of 30 normal volunteers served as controls.Both Humphery (10-2) and Maia (expert 10-2) were performed on the subjects respectively and the correlation of the results between Humphery (10-2) and Maia (expert 10-2) were analyzed.Then the patients with normal hemifield on Humphrey were assigned to Maia normal group and Maia abnormal group.Fixation stability differences were compared between glaucoma group and normal control group,and between Maia normal group and Maia abnormal group.Results The moderately positive correlation was found in the mean sensitivity between Maia microperimetry and Humphrey perimetry (r=0.403,P =0.001),and the average threshold of Maia microperimetry was moderately positive correlated with the mean defect (MD) of Humphrey perimetry in glaucoma patients (r=0.438,P =0.008).The fixation stability parameter P1 was (67±17)％ and (87±10)％,and that of P2 was (70±16)％ and (88±9)％;the 63％ bicurve elipse area (BCEA) was (5.08±1.55) °2and (2.21±0.60) °2,and the 95％ BCEA was (14.74± 6.04) °2 and (2.86 ± 1.17)°2 in the glaucoma group and normal control group,respectively,showing significant decreases of P1 and P2 and increases of 63％ BCEA and 95％ BCEA in the glaucoma group compared with the normalcontrol group (t=-5.604,-4.831,9.885,11.086,all at P=0.000).In Maia normal group and Maia abnormal group,the P1 was (79±8)％ and (63±17)％,the P2 was (81±10)％ and (67±16)％,the 63％ BCEA was (3.19±0.65)°2 and (5.70±1.22)°2 and the 95％ BCEA was (9.10±2.60)°2 and (19.35±5.01)°2,respectively.Compared with the Maia normal group,the P1 and P2 were significantly lower,and 63％ BCEA and 95 ％ BCEA were higher in the Maia abnormal group (t=-2.468,P=0.019;t=-2.371,P=0.024;t =5.514,P=0.000;t=5.575,P=0.000).Conclusions Maia microperimetry and Humphrey perimetry yield a good correlation for glaucomatous macular function examination.In addition,Maia microperimetry showed that fixation stability decreased in glaucoma patients with hemifield defect.

Microperimetry biofeedback training in a patient with bilateral myopic macular degeneration with central scotoma.

Microperimetry‑1 (MP‑1) evaluation and MP‑1 biofeedback training were done in a case of bilateral myopic macular degeneration with a central scotoma. Fixation behavior, location and stability of preferred retinal locus, eye movement speed, and mean sensitivity were assessed. The mean retinal sensitivities before, after and at 1‑year after training in the right eye were 2.9 dB, 2.9 dB and 3.7 dB and in the left eye were 3.5 dB, 3.7 dB and 1.8 dB. The fixation point in the 2° gravitation circle, improved from 40% to 50% in the right eye and from 43% to 67% in the left eye. The average eye speed before, after and at 1‑year after training in right eye were 0.19°/s, 0.26°/s and 0.25°/s and in left eye were 0.36°/s, 0.25°/s and 0.27°/s. Thus, biofeedback training using MP‑1 can improve the visual function in patients with macular diseases and central scotoma.

Microperimetría en la cirugía del agujero macular idiopático / Microperimetry in the idiopathic macular hole surgery

Objetivo: demostrar la utilidad de la microperimetría pre y posoperatoria en operados de agujero macular idiopático entre 2010-2012, en el Instituto Cubano de Oftalmología Ramón Pando Ferrer. Métodos: en una investigación longitudinal-prospectiva de 17 operados de agujero macular, se estudiaron la agudeza visual corregida y la microperimetría preoperatoria y posoperatoria. Se estableció como mejoría de la agudeza visual corregida si mejoraban dos líneas o más y como mejoría de la microperimetría si cumplían al menos dos de los parámetros: desaparición de escotoma absoluto, desaparición de escotoma relativo y mejoría de la sensibilidad retineana. Se efectuó el examen oftalmológico y la tomografía óptica coherente pre y posoperatorios, en los que se precisó la presencia y el cierre del agujero. Resultados: en la microperimetría preoperatoria presentaban escotoma absoluto el 64,71 por ciento, y escotoma relativo el 94,12 por ciento; la sensibilidad retiniana media fue de 8,40 ± 4,39 y la fijación era estable en el 81,82 por ciento de los pacientes. La sensibilidad retineana media preoperatoria presentó significación estadística respecto a la mejoría de la agudeza visual (p= 0,012). De los pacientes con cierre del agujero (64,71 por ciento), el 72,73 por ciento mejoró la agudeza visual (p= 0,006), y el 54,55 por ciento mejoró la microperimetría (p= 0,002). Se encontró significación estadística entre el cierre del agujero macular y la mejoría de la agudeza visual corregida (p= 0,009) y entre el cierre y la mejoría de la microperimetría (p= 0,043). Conclusiones: la sensibilidad retineana preoperatoria puede constituir un factor predictivo para la recuperación funcional del agujero macular. La recuperación de la agudeza visual tras el cierre del agujero conlleva la mejoría de la microperimetría. Esta última constituye un punto de apoyo para continuar la recuperación funcional(AU)

Objetive: to demonstrate utility of microperimetry to the surgery of idiopathic macular hole, among 2010-2012, in the "Ramón Pando Ferrer" Cuban Ophthalmology Institute. Methods: a longitudinal-prospective study of 17 patients who underwent surgery for idiopathic macular hole was carried out. The corrected visual acuity and microperimetry were studied before and after the surgery. If patient improved 2 lines or more of corrected visual acuity and if they having 2 of the items: disappearance of absolute scotoma, disappearance of scotoma relative, improvement of retinal sensitivity; were established improvement of them. Oftalmology exam and optic coherent tomography were studied before and after surgery, specifying the presence and close of the hole. Results: 64,71 percent of patients presented absolute scotoma and 94,12 percent of them had relative scotoma. The mean retinal sensitivity was 8,40 ± 4,39 and fixation was stable in 81,82 percent of them. Better preoperative mean retinal sensitivity showed statistical significance to best corrected visual acuity (p= 0,012). 72,73 percent of patients with close surgical of the hole (64,71 percent) improved corrected visual acuity (p= 0,006), and 54,55 percent of them improved the microperimetry (p= 0,002). The anatomical closing of hole showed statistical significance for the improvement of corrected visual acuity (p=0,009) and for the improvement of microperimetry (p= 0,043). Conclusions: the preoperative retinal sensitivity can predict the functional recovery of the macular hole. After close of the hole, the recovery of visual acuity can precede to improvement of microperimetry. Microperimetry can constitute a support point to continue the functional recovery(AU)

Association between Microperimetric Parameters and Optical Coherent Tomographic Findings in Various Macular Diseases

PURPOSE: To analyze the correlation between microperimetric parameters and optical coherent tomographic findings in the eyes of patients with macular diseases. METHODS: A total of 64 eyes were included in this retrospective cross-sectional study. Differences in the macular integrity index and microperimetric parameters were analyzed according to types of outer retinal band defects. Correlations between average threshold values and retinal thickness in the corresponding areas were analyzed. Finally, microperimetric parameters were compared between inner and outer retinal lesions. RESULTS: Measures of best-corrected visual acuity, macular integrity index, and average threshold values were significantly worse in eyes with defects in the ellipsoid portion of the photoreceptor inner segment (ISe), the cone outer segment tip (COST), and the external limiting membrane (ELM) than in eyes without ISe, COST, and ELM defects. Also, visual functionality is more significantly impacted by ELM defects than by other hyper-reflective band defects. There was a significant negative correlation between retinal thickness and the average threshold of the corresponding area in the Early Treatment Diabetic Retinopathy Study grid. Microperimetric parameters in the eyes of patients with inner retinal lesions were better than in the eyes of patients with outer retinal lesions. CONCLUSIONS: The macular integrity index may be a useful factor for reflecting the functional aspects of macular diseases. Specifically, ELM, ISe, and COST defects are significantly associated with poor retinal sensitivity and macular integrity index values that suggest abnormalities. Among eyes with these particular defects, the visual functionality of patients is most sensitively impacted by ELM defects. This finding suggests that microperimetric parameters are sensitive and useful for evaluating functional abnormalities in the eyes of patients with macular disease, particularly in patients with outer retinal pathology.

Research progress of foveoschisis in pathological myopia / 国际眼科杂志(Guoji Yanke Zazhi)

?Pathological myopia are often complicated by a series of pathological changes in fundus including foveoschisis, which can lead to visual dysfunction when processing with retinal detachment, macular hole, epiretinal membrane and vitreoretinal traction diseases. According to the current knowledge, the main mechanism of foveoschisisi might be attributed to the impaired macular structure and function caused by a variety of traction on the retinal and retina poor condition. Surgical treatments have been reported to be effective in treating foveoschisis, however, the indications and surgical procedures are still controversial. ln this article, we reviewed the clinical features, diagnosis, treatment strategies and prognosis of pathological myopia foveoschisis.

Evaluation of macular function in open angle and angle-closure glaucomatous eyes by microperimetry / 中华实验眼科杂志

Background The biomeasurement and imageology of retinal nerve fiber layer(RNFL) thickness showed the damage of retinal structure in the early and middle stage of glaucomatous eye,however,the subtle functional damage of glaucoma can not be timely reflected only with automatic static perimeter.Microperimetry is a method of quantitatively assessing mean sensitivity (MS) of macular zone.Objective This study was to evaluate and compare the macular functional change in early and middle stage of primary open angle glaucoma (POAG) and chronic angle-closure glaucoma (CACG) with MP-1 microperimeter.Metbods This trail protocol was approved by Ethic Committee of Peiking University Third Hospital,and written informed consent was obtained from each subject prior to entering the study group.A cross-sectional and case-controlled study was designed.A total of 126 eyes from 126 subjects were enrolled in the trail,including 53 eyes of 53 normal subjects,50 eyes of POAG patients and 23 eyes of CACG patients.A macular 10° program was set with MP-1 microperimetry to record the MS of various subareas.The macula was zoned into central 2°,6°,and 10° visual fields and 4 quadrants in each ring.The MS of different rings and subareas was detected and compared among POAG patients,CACG patients and normal controls.Results The MS values of central 2°,6°,10° and whole macular area were (15.09 ± 3.03),(15.72 ± 3.22),(13.99 ± 3.63) and (14.91±3.07)dB in the POAG group,which were significantly lower than those of (17.29±1.59),(18.05±1.24),(16.76±1.89) and (17.37±1.46)dB in the normal control group (all at P=0.000).The MS values of central 2°,6°,10° and whole macular area was (16.00±2.39),(15.83±2.63),(14.45±3.15) and (15.42±2.54) dB in the CACG group,and the reduced MSs were seen at the 6°,10° rings and whole macular area in the CACG group compared with the normal control group (P =0.004,0.013,0.011).Within the 6° ring,the MS values in the inferotemporal quadrant were declined in the POAG group and CACG group compared with the normal control group (P =0.000,0.022),but the difference was not statistically significant between the POAG group and the CACG group (P =0.311).In addition,the MS value in the inferonasal quadrant was significantly lower than that of the normal control group (P =0.005); while that in the CACG group was not significantly different in comparison with the normal control group (P=0.119).In the POAG group,the MS value of the inferotemporal quadrant was significantly lower than that of the superonasal or superotemopral quadrant (P =0.043,0.016),but no significant differences were found among the 4 quadrants in the CACG group (all at P＞0.05).Conclusions The mild damage of retinal function appears in the early and middle stage of POAG and CACG.More serious MS reducing occurs in the inferotemporal and inferonasal quadrants of POAG.

Is there a correlation between structural alterations and retinal sensitivity in morphological patterns of diabetic macular edema.

Spectral domain optical coherence tomography (SDOCT) enables enhanced visualization of retinal layers and delineation of structural alterations in diabetic macular edema (DME). Microperimetry (MP) is a new technique that allows fundus-related testing of local retinal sensitivity. Combination of these two techniques would enable a structure-function correlation with insights into pathomechanism of vision loss in DME. To correlate retinal structural derangement with retinal sensitivity alterations in cases with diabetic macular edema, using SDOCT and MP. Prospective study of 34 eyes of 30 patients with DME. All patients underwent comprehensive ophthalmic examination, fluorescein angiography, microperimetry and SDOCT. Four distinct morphological patterns of DME were identified- diffuse retinal thickening (DRT), cystoid macular edema (CME), schitic retinal thickening (SRT) and neourosensory detachment (NSD) of fovea. Some retinal loci presented with a mixture of above patterns There was significant difference in retinal thickness between groups (P<0.001). Focal retinal sensitivity measurement revealed relatively preserved retinal sensitivity in areas with DRT (13.8 dB), moderately reduced sensitivity (7.9 dB) in areas with CME, and gross retinal sensitivity loss in areas with SRT (1.2 dB) and NSD (4.7 dB) (P<0.001). Analysis of regional scotoma depth demonstrated similar pattern. Retinal sensitivity showed better correlation to OCT pattern (r=-0.68, P<0.001) than retinal thickness (r=-0.44, P<0.001). Structure-function correlation allows better understanding of the pathophysiology of visual loss in different morphological types of DME. Classification of macular edema into these categories has implications on the prognosis and predictive value of treatment.

Relación estructura función en la detección de daño retinal por cloroquina / Relation of structure and function in detecting the retinal damage due to chloroquine

Objetivo: determinar la utilidad de la microperimetría y la tomografía óptica coherente en la detección de daño retinal subclínico por cloroquina. Métodos: estudio prospectivo, observacional y analítico en pacientes consumidores de cloroquina, atendidos en la consulta de Neuroftalmología del Instituto Cubano de Oftalmología Ramón Pando Ferrer, entre septiembre 2010 y octubre 2011. Fueron incluidos 44 ojos. Se realizaron exámenes para evaluar función (psicofísica visual y microperimetría) y estructura (biomicroscopia y tomografía óptica coherente). Resultados: la edad promedio fue de 43 años con una dosis acumulada de cloroquina de 182 g y un tiempo de consumo inferior a cinco años. Existió relación significativa entre la dosis acumulada y las variables siguientes: visión del color (-0,495; p= 0,001), grosor retinal peripapilar temporal (-0,353; p= 0,019) e inferior (-0,336; p= 0,026), macular central (-0,652; p= 0,000) y sensibilidad retinal por microperimetría (-0,436; p= 0,003) con alteraciones funcionales y estructurales en relación con el incremento de la dosis acumulada. Conclusiones: se demostró que es posible detectar daño retinal funcional temprano mediante microperimetría y tomografía óptica coherente en pacientes consumidores de cloroquina, en presencia de otros estudios funcionales y biomicroscopia normales. Unido a la tomografía óptica coherente el microperímetro puede constituir una útil herramienta para pesquisa de toxicidad retiniana

Objective: to determine the usefulness of microperimetry and of the optical coherence tomography in the detection of subclinical retinal damage due to chloroquine. Methods: prospective, observational and analytical study in patients taking chloroquine, who were seen at the Neuro-ophthalmology service of "Ramón Pando Ferrer" Institute of Ophthalmology from September 2010 through October 2011. Forty four eyes were included. Tests were performed to assess function (visual psychophysics and microperimetry) and structure (biomicroscopy and optical coherence tomography). Results: mean age was 43 years with a cumulative dose of 182 g and less than 5 years taking this drug. There was significant correlation between the cumulative dose of chloroquine and the following variables: color vision (-0.495, p = 0.001), temporal peripapillary retinal thickness (-0.353, p= 0.019) and lower (-0.336, p = 0.026), central macular (-0.652, p = 0.000) and retinal sensitivity by microperimetry (-0.436, p= 0.003) with functional and structural changes related to the increase in cumulative dose. Conclusions: it was demonstrated that it is possible to detect early functional retinal damage by using microperimetry and optical coherence tomography in patients taking chloroquine, despite normal results of other functional studies and of biomicroscopy. The combination of microperimetry and optical coherence tomography may be a useful screening tool for retinal toxicity

Improvement of central retinal sensitivity six months after topical isopropyl unoprostone in patients with retinitis pigmentosa.

Aims: Isopropyl unoprostone (IU), a maxi-K channel activator, is used topically to treat glaucoma, and has been reported to have neuroprotective effects on retinal neurons in vitro and in vivo. The purpose of this non-comparative pilot study was to determine whether topical IU will alter the sensitivity of the central retina in patients with retinitis pigmentosa (RP). Settings and Design: Non-comparative pilot study. Materials and Methods: IU was given topically twice a day for 6 months to both eyes of 30 patients with typical RP. The visual acuity was measured with a Japanese Snellen chart, and the mean retinal sensitivities were obtained by fundus-related microperimetry (MP-1). The mean deviation (MD) of the visual field was determined with a Humphrey field analyzer (HFA). All measurements were made before and 6 months after the treatment. Statistical Analysis Used: Wilcoxon and the Mann-Whitney U tests (SPSS, SPSS Inc., Chicago, IL). Results: After the treatment, the mean retinal sensitivity within the central 2° and 10° improved significantly from 12.3 ± 4.8 dB to 14.7 ± 5.5 dB (P = 0.001) and from 9.1 ± 5.4 dB to 11.0 ± 6.2 dB (P = 0.001), respectively. Conclusions: These short-term results suggest topical IU can improve the central retinal sensitivity in RP patients. It will be necessary to examine longer treatment periods in a controlled study to determine the effectiveness of topical IU in RP patients.