Functional and morphological evaluation of autologous retinal graft in large traumatic macular hole

A 7-year-old boy presented with history of blunt trauma 1 month back. Best corrected visual acuity (BCVA) was 20/200 with optical coherence tomography (OCT) showing a large macular hole. Spontaneous closure of the macular hole seemed unlikely following a month of observation. Pars plana vitrectomy along with autologous retinal graft was performed. At subsequent follow up, hole appeared closed with nasal shrinkage of graft and BCVA improved to 20/100. OCT showed mechanical integration of the graft with adjoining retina. Autologous retinal graft is a feasible option in cases where conventional internal limiting membrane peeling shows lower anatomical success.

A Case of Acute Macular Neuroretinopathy in a Young Male

PURPOSE: We report a rare case of unilateral acute macular neuroretinoapthy in a young male. CASE SUMMARY: A 35-year-old male presented with a 2-day history of paracentral scotoma. He had suffered for 2 days from a flu-like illness, and his best corrected visual acuity was 20/20 OD and 20/20 OS. Pupillary reflex was normal and no relative afferent pupillary defects were not found. Ocular movement test was normal and pain on ocular movement was not noticed. Ophthalmoscopic examination of the left eye revealed multiple exudates lining the nasal macula toward the fovea. A Humphrey visual field study identified small paracentral scotoma. Spectral domain optical coherence tomography (SD-OCT, Heidelberg Engineering, Heidelberg, Germany) of the lesions showed a hyper-reflective lesion located in the outer plexiform layer and inflammatory cell infiltration. Fluorescent angiography was normal in the macula but showed late leak at the disc. The multifocal electroretinogram (mfERG) showed decreased foveal P1 amplitude in the left eye. The patient was diagnosed with acute macular neuroretinopathy and was treated with 60 mg of prednisolone. His subjective symptoms were improved, the paracentral scotoma disappeared, and the lesions appeared different upon SD-OCT; specifically, the hyper-reflective lesion disappeared and the outer plexiform layer showed thinning. CONCLUSIONS: Acute macular neuroretinopathy is a rare disease, and we report a case using SD-OCT and mfERG.

Multifocal Electroretinography in Retinitis Pigmentosa With Non-recordable Full-field Electroretinography

PURPOSE: To investigate the clinical potential of multifocal electroretinography (mf-ERG) for the evaluation of residual retinal function in retinitis pigmentosa (RP). METHODS: From a group of 41 patients with RP examined for full-field and mf-ERGs, 24 patients were selected in whom the full-field ERGs were non-detectable. Data from the mf-ERGs of this group were reviewed retrospectively. Patients were divided into two groups based on best corrected visual acuity (BCVA); Group A, with a BCVA of less than 0.5, and group B with a BCVA greater than 0.5. The amplitudes and implicit times of Ring 1 and Ring 2 among six concentric rings were measured for comparison between mf-ERG groups. RESULTS: In the mf-ERGs, the amplitudes of Ring 1 and Ring 2 were reduced and implicit time was delayed in all 48 eyes of 24 patients in whom scotopic and photopic responses were non-detectable in full-field ERGs, whereas, there were no detectable responses in Rings 3 thru 6. There was a greater reduction in amplitude and an increased delay in implicit time in group A. CONCLUSIONS: The mf-ERG can estimate the residual macular function in a group of patients with RP in whom the full-field ERG is non-recordable.

Follow-Up Changes of Multifocal Electroretinogram in a Patient with Vogt-Koyanaki-Harada Syndrome

PURPOSE: To assess the changes of retinal function together with recovery progress in a patient with Vogt-Koyanaki-Harada syndrome using a multifocal electroretinogram (mfERG). METHODS: The retinal changes of a 32-year-old woman diagnosed with Vogt-Koyanaki-Harada syndrome have been investigated and compared for different times such as before treatment and 3 and 6 months after treatment using a fluorescein angiogram, electroretinogram (ERG) and mfERG. RESULTS: As time passed, the patient's visual acuity was recovered, the serous retinal detachment in the posterior pole was restored, and the phenomenon of late subretinal leakage disappeared on fluorescein angiogram, while aggregation and atrophy of the retinal pigment epithelium were detected. The early-stage responses of the retina decreased on ERG; however, it has gradually recovered and was determined to be normal after 6 months. Responses measured on the mfERG have increased during the 6 months after surgery compared to the pre-treatment, but there was still a partial lack of response. CONCLUSIONS: In this case, the abnormal condition of retinal function existed continuously on the mfERG, even when the serous retinal detachment in the posterior pole was recovered. In this regard, a long-term systematic investigation and subsequent mfERG treatment have been thought to be necessary for patients with this disease.

Effect of Refractive Error on the Multifocal Electroretinogram

PURPOSE: To evaluate the influence of refractive blur on the results of mfERG. METHODS: mfERG was performed on 10 healthy volunteers with a refractive error within +/- 1 diopter. The central 30 degrees of the ocular fundus were stimulated by an array of 103 hexagonal elements, for four minutes, using VERISTM. To change the refractive status, 6-cm diameter corrective lens, of -6, -4, -2, plano, +2, +4, and +6 diopters, were placed in front of the eyes, and the examination distance adjusted to compensate retinal image size changes due to corrective lens. The mfERG responses were grouped by 6 concentric rings, and then averaged. For each ring, the latencies and amplitudes of the N1, P1 and N2 were analyzed. The 6 rings were divided into the central (ring 1, 2) and peripheral (ring 3~6) retina, and the latencies and amplitudes of the N1, P1 and N2 were then also analyzed. RESULTS: Refractive blur can affect the results of the mfERG. Latency delay was more common at the peripheral than central retina, but had no statistically significant correlations with the refractive power increase. CONCLUSIONS: When the viewing distance was adjusted to create a constant retinal image size, the influence of refractive blur may cause some changes in the mfERG results. Therefore, when evaluating the results of an mfERG, the effects of the refractive error should be borne in mind.

Evaluation of retinal function after retinal transplantation for light-induced retinal degeneration in miniature pigs / 第三军医大学学报

Objective To investigate the possibility that transplanting the full-thickness neonatal piggy retinas that are completely differentiated but immature improves the retinal function after light-induced retinal degeneration in pigs.Methods Retinas from normal Guangxi Bama pigs aged 1-6 days were used as donor tissues.Neuroretina-RPE cografts were obtained from newborn pigs by using excimer laser for microablation of choroidal tissue and transplanted into the subretinal cavity of adult Bama pigs after light-induced retinal degeneration through vitrectomy and retinotomy.On days 5-7 and in 1st to 5th month after retinal transplantation,the survival of the cografts in the recipients and whether the host retinas have rejection were observed by ophthalmoscope,colour fundus photography and fundus fluorescein angiography,and the amplitude and lantency of N1,P1 waves between different periods were measured by mfERG.Results The retinal transplantation was performed in 15 eyes of 8 Bama pigs after light-induced retinal degeneration.The subretinal transplantation of the cografts was performed successfully in 11 eyes,with the operation success rate of 84.6%(11/15).In host retina,the gray-black graft inside transplantation bed could be seen clearly in 1st to 2nd month after transplantation and the leaked fluorescence in transplants was checked with FFA.The vertical comparison between different periods showed the amplitude of N1,P1 waves of retinal transplants rose with the extension of the survival time,and the areas where active response was observed were ring 2 and ring 3;but the latency of N1,P1 waves was shortened significantly in each ring as compared with that before operation,especially in late survival period.Conclusion The function measurement and the observation of living body together confirm the transplantation of completely differentiated retina from newborn pigs improves the retinal function of pigs after light-induced retinal degeneration.

To utilize reasonably the morphological and functional examinations for diagnosing macular diseases / 眼科

Advantages and disadvantages of morphologic and functional examinations for macular disease were reviewed. These examinations included optical coherence tomography(OCT), Heidelberg retina tomograph(HRT), and multifocal electroretinography (mfERG), etc. It is very important to improve ability of diagnosis and management of macular disease by choosing examination logically and integrating morphologic examination with functional examination on the basis of disease.