SURGICAL MANAGEMENT OF FULL-THICKNESS MACULAR HOLE SUPERIMPOSED ON EXUDATIVE AGE-RELATED MACULAR DEGENERATION.

BACKGROUND/PURPOSE: We describe a case of full-thickness macular hole formation in a patient with exudative age-related macular degeneration after an intravitreal ranibizumab injection and its surgical management. METHODS: This case is a retrospective, interventional case report. RESULTS: A 77-year-old woman with bilateral exudative age-related macular degeneration and pre-existing retinal pigment epithelium tear developed a full-thickness macular hole after intravitreal ranibizumab. The macular hole was repaired successfully with pars plana vitrectomy, internal limiting membrane peel, and 16% C3F8 gas fill. CONCLUSION: To the best of our knowledge, this is the first reported case of full-thickness macular hole after a retinal pigment epithelium tear repaired successfully with vitrectomy, resulting in improved visual acuity.

Adaptation of the steady-state PERG in early glaucoma.

PURPOSE: Previous studies have shown that the onset of high-contrast, fast reversing patterned stimuli induces rapid blood flow increase in retinal vessels in association with slow changes of the steady-state pattern electroretinogram (PERG) signal. We tested the hypothesis that adaptive PERG changes of normal controls differed from those of glaucoma suspects and patients with early manifest glaucoma. METHODS: Subjects were 42 glaucoma suspects (Standard Automated Perimetry-MD -0.89±1.8 dB), 22 early manifest glaucoma (MD -2.12±2.4 dB) with visual acuity of ≥20/20 and 16 age-matched normal controls from a previous study. The PERG signal was sampled every ~15 seconds over 4 minutes in response to gratings (1.6 cyc/degree, 100% contrast) reversing 16.28 times/s. Amplitude/phase values of successive PERG samples were fitted with a nonparametric locally weighted polynomial regression smoothing function to retrieve the initial and final values and calculate their difference (δ) and the residual SD around the fitted function. The magnitude of PERG adaptive change compared to random variability was calculated as log10 of percentage coefficient of variation (CoV)=100×residual SDr÷δ. Grand-average PERGs were also obtained by averaging all samples of the same series. RESULTS: The grand-average PERG amplitude [analysis of variance (ANOVA), P=0.02], but not phase (ANOVA, P=0.63), decreased with increasing severity of disease. Adaptive changes [log10 (CoV)] of PERG amplitude were not significantly associated with disease severity (ANOVA, P=0.27) but adaptive changes [log10 (CoV)] of PERG phase were (ANOVA, P=0.037; linear trend, P=0.011). CONCLUSIONS: The steady-state PERG signal displayed slow adaptive changes over time that could be isolated from random variability. PERG adaptive changes differed from those of grand-average PERGs (corresponding the standard steady-state PERG), thus representing a new source of biological information about retinal ganglion cell function that may have potential in the study of glaucoma and optic nerve diseases.

Progressive loss of retinal ganglion cell function precedes structural loss by several years in glaucoma suspects.

PURPOSE: We determined the time lag between loss of retinal ganglion cell function and retinal nerve fiber layer (RNFL) thickness. METHODS: Glaucoma suspects were followed for at least four years. Patients underwent pattern electroretinography (PERG), optical coherence tomography (OCT) of the RNFL, and standard automated perimetry testing at 6-month intervals. Comparisons were made between changes in all testing modalities. To compare PERG and OCT measurements on a normalized scale, we calculated the dynamic range of PERG amplitude and RNFL thickness. The time lag between function and structure was defined as the difference in time-to-criterion loss between PERG amplitude and RNFL thickness. RESULTS: For PERG (P < 0.001) and RNFL (P = 0.030), there was a statistically significant difference between the slopes corresponding to the lowest baseline PERG amplitude stratum (≤50%) and the reference stratum (>90%). Post hoc comparisons demonstrated highly significant differences between RNFL thicknesses of eyes in the stratum with most severely affected PERG (≤50%) and the two strata with least affected PERG (>70%). Estimates suggested that the PERG amplitude takes 1.9 to 2.5 years to lose 10% of its initial amplitude, whereas the RNFL thickness takes 9.9 to 10.4 years to lose 10% of its initial thickness. Thus, the time lag between PERG amplitude and RNFL thickness to lose 10% of their initial values is on the order of 8 years. CONCLUSIONS: In patients who are glaucoma suspects, PERG signal anticipates an equivalent loss of OCT signal by several years.

Effects of Ginkgo biloba administered after spatial learning on water maze and radial arm maze performance in young adult rats.

Ginkgo biloba is reported to improve learning and memory in animals. However, many studies do not directly test the effects of Ginkgo on memory because the drug is administered during the learning phase of the experiments. In this study, we examined the effect of 10 mg/kg, 20 mg/kg, or 40 mg/kg G. biloba extract on spatial memory by administering the drug in the interval between training and testing. Rats were tested for long-term reference memory retention in the radial arm maze and in the Morris water maze during daily probe trials in which the hidden platform was removed. G. biloba had no effect on reference memory in either the water maze or radial arm maze. To test short-term working spatial memory using the radial arm maze, animals were removed after receiving the reward from 4 of the 8 arms and were returned to complete the maze 2 h later. While Ginkgo had no effect on working memory, over time animals exposed to Ginkgo learned task better than control animals. Thus, Ginkgo appears to enhance neither short-term working memory nor long-term reference memory, but it may promote learning of spatial information.