Functional and structural assessment of lamellar macular holes.

AIM: The purpose of the present work was to evaluate the macular sensitivity of patients with lamellar macular hole (LMH) by means of microperimetry, and to explore the relationships between macular function, LMH anatomical characteristics and vitreous status. METHODS: A total of 39 eyes from 37 patients with a diagnosis of LMH and 20 age-matched control subjects were enrolled. All patients underwent a complete ophthalmological examination including visual acuity testing (logMAR) and MP1 microperimetry. LMHs were quantitatively and qualitative characterised by spectral domain optical coherence tomography (OCT) in terms of base and apex diameter, depth, central foveal and perifoveal thickness, splitting location and integrity of outer retina layers. B scan ultrasonography was performed in order to characterise the vitreoretinal relationships. RESULTS: Mean total (17.2 ± 2.2 vs 19.6 ± 0.5 dB, respectively, p<0.0001) and mean central (16.1 ± 3.2 vs 19.2 ± 0.7 dB, p < 0.0001) retinal sensitivity were significantly reduced in LMH eyes in comparison with controls. Best corrected visual acuity (BCVA) (0.15 ± 0.15 vs 0.03 ± 0.06 logMar, p = 0.001) and central retinal thickness (329.05 ± 59.3 vs 265 ± 28.5 µm, p < 0.0001) were significantly worse in LMH eyes in comparison with controls. In our population, mean total and central retinal sensitivity showed a moderately significant relationship with LMH depth (R(2) 0.18, p = 0.006, R(2) 0.14, p = 0.02, respectively). In all, 38% of LMH eyes (15/39) showed focal interruptions of the inner-outer segment junction with lower values of BCVA and macular sensitivity. An incomplete posterior vitreous detachment with vitreopapillary adhesion was found in 48.7% (19/39) of patients with LMH. CONCLUSIONS: Eyes with LMH show an impaired macular function, which is partially related to LMH depth and is more pronounced in eyes with outer retinal layers abnormalities.

Bietti crystalline dystrophy: a morpho-functional evaluation.

We report the clinical findings and macular function of a patient with Bietti crystalline dystrophy. A 39-year-old woman reported visual loss in both eyes and nyctalopia. A complete ophthalmological evaluation, retromode imaging, SD-OCT acquisition, MP1 microperimetry, and multifocal electroretinogram (mfERG) were performed. Microcrystalline deposits in the cornea and the retina with retinal pigment epithelial atrophy were observed. Retromode imaging revealed visualization of normal large choroidal vessels, cystoid macular edema, and small defined glistening lesions. SD-OCT showed changes in the outer retina with numerous microcrystalline deposits. Microperimetry showed an absolute scotoma involving the perimacular area but sparing of the fovea. In both eyes, mfERG analysis suggests a dysfunction of pre-ganglionic retinal elements detectable in the 20 central retinal degrees. The genetic characterization showed an homozygous mutation c.772C > T[p.Leu258Phe] in exon 6. Retromode imaging and SD-OCT were useful tools to determine the extent and the localization of the crystals. Microperimetry should allow evaluation of the progression of the macular changes.

Macular function after PDT in myopic maculopathy: psychophysical and electrophysiological evaluation.

PURPOSE: To evaluate the effects of photodynamic therapy (PDT) on macular function in myopic subfoveal choroidal neovascularization (CNV). METHODS: Fourteen eyes of 14 patients (mean age, 48.1 +/- 13.3 years) with myopic CNV (myopia ranging from -6.50 to -20 D) were enrolled. In each eye, at baseline and at 15 and 90 days after PDT with verteporfin, logMAR visual acuity (logarithm of the minimum angle of resolution VA), macular sensitivity by scanning laser ophthalmoscope microperimetry, and focal (central 9 x 9 degrees ) ERGs (FERGs) and pattern ERGs (PERGs) were assessed. RESULTS: At 15 days after PDT, myopic CNV eyes showed, in relation to baseline values, a significant (ANOVA, P < 0.01) reduction in the diameter of the lesion that correlated (Pearson test, P < 0.01) with the significant (ANOVA, P < 0.01) increase in FERG and PERG amplitudes, VA, and scanning laser ophthalmoscopy (SLO) microperimetry results obtained from the central 1 degrees to 2 degrees of the macular area (SLO-CM). At 90 days after PDT, myopic CNV eyes showed, in comparison with baseline values, a nonsignificant (ANOVA, P > 0.01) reduction in the diameter of the lesion, a nonsignificant increase in VA and SLO-CM, and a still significant increase in FERG and PERG amplitudes. CONCLUSIONS: In myopic CNV eyes, PDT induces an increase, though not significant, in VA and macular sensitivity. These changes may be related to a reduction in the diameter of the lesion, with an improvement in the function of both ganglionic and preganglionic elements of the macular region, as suggested by the improvement in FERG and PERG responses.

Development of macular pseudoholes: a 36-month period of follow-up.

PURPOSE: To assess the changes in visual acuity and macular sensitivity and the possible evolution into a full-thickness macular hole in patients with macular pseudoholes during a 3-year follow-up period. METHODS: Twenty-seven eyes (mean age, 61.0 +/- 8.9 years) with macular pseudoholes were enrolled. They were compared with 16 eyes from 16 age-matched control eyes. In each eye with a macular pseudohole, we assessed the Snellen visual acuity and macular sensitivity by scanning laser ophthalmoscopic central (1-2 degrees of the macula, SLO-CM) and paracentral (annular area from 2-7 degrees from the macula, SLO-PM) microperimetry at the time of diagnosis (baseline condition) and every 6 months for 3 years. RESULTS: Eyes with macular pseudoholes at baseline had a significant (P < 0.05) reduction in visual acuity, SLO-CM, and SLO-PM when compared with control eyes. After 12 months of follow-up, no changes in VA, SLO-CM, or SLO-PM were observed in eyes with macular pseudoholes with respect to the baseline values. After 36 months of follow-up, further significant (P < 0.05) decreases in visual acuity, SLO-CM, and SLO-PM were observed. One third of eyes with macular pseudoholes showed an evolution into a full-thickness macular hole. In these eyes, the lowest SLO-CM had been observed at the baseline condition. CONCLUSION: This study suggests that in the 36-month follow-up period in eyes with macular pseudoholes, there is the possibility of a worsening trend, leading to the development of a full-thickness macular hole. A useful role of the functional assessment by SLO-CM and SLO-PM can be suggested for the clinical diagnosis and the follow-up of macular pseudoholes.