Correlation between functional and anatomical assessments by multifocal electroretinography and optical coherence tomography in central serous chorioretinopathy.

To evaluate the correlation between functional and anatomical assessments with multifocal electroretinography (mfERG) and optical coherence tomography (OCT) in patients with acute central serous chorioretinopathy (CSC). Thirty-four eyes of 34 patients with acute CSC underwent mfERG and OCT examinations. First-order mfERG N1 and P1 response amplitudes and latencies were analyzed.OCT parameters measured included central subretinal fluid (SRF) thickness, central retinal thickness, total central foveal thickness, vertical, and horizontal diameters of SRF, and macular volume. Correlation analyses were performed between best-corrected visual acuity (BCVA), mfERG parameters, and OCT measurements. Correlation analysis showed that logMAR BCVA was significantly correlated with mfERG N1 amplitudes of rings 1 and 2 (P = 0.006), N1 latency of ring 4 (P = 0.012), and P1 latency of ring 1 (P = 0.036). No significant correlation was observed between logMAR BCVA and any of the OCT measurements. For the correlation between mfERG parameters and OCT measurements, mfERG N1 and P1 latencies of the paracentral rings were significantly correlated with the central SRF thickness (P < or = 0.024), diameters of the SRF (P < or = 0.018), and macular volume (P < or = 0.030). MfERG responses but not OCT measurements correlated with logMAR BCVA in patients with acute CSC. The amount of SRF nonetheless correlated with the mfERG N1 and P1 latencies of the paracentral rings, suggesting that impairment in the conduction of electrical responses in the paracentral macula is proportional to the severity of serous macular detachment in CSC. MfERG and OCT can complement each other in the functional and anatomical assessments in CSC.

Changes in first- and second-order multifocal electroretinography in idiopathic macular hole and their correlations with macular hole diameter and visual acuity.

PURPOSE: To evaluate the first- and second-order multifocal electroretinography (mfERG) responses in patients with idiopathic macular hole, and their correlations with macular hole diameter measured by optical coherence tomography (OCT) and visual acuity. METHODS: Twenty-four eyes of 24 patients with idiopathic macular hole underwent mfERG and OCT examinations. The response amplitudes and implicit times of the first- and second-order mfERG were analyzed and compared with 20 age-similar normal control subjects. Correlation analyses between visual acuity, apical and basal diameters of the macular hole, and the first- and second-order mfERG amplitudes and implicit times were performed. RESULTS: The first-order mfERG N1 and P1 amplitudes in the central two concentric rings were reduced in macular hole eyes compared with controls (p < 0.006). For the second-order mfERG, only the N1 mfERG amplitude was significantly reduced at ring 6 in macular hole eyes compared with controls (p = 0.030). Correlation analysis showed that apical diameter of macular hole was significantly correlated with the first-order N1 amplitude of rings 2 to 5 (p < 0.024), the first-order P1 amplitude of rings 2 to 6 (p < 0.05), as well as the second-order P1 mfERG amplitudes of rings 3 to 6 and N1 amplitudes of rings 3 to 5 (p < 0.05). LogMAR visual acuity showed significant correlation with apical diameter of the macular hole (p = 0.002), and also with the first-order P1 amplitude of ring 2 (p = 0.024). CONCLUSION: In eyes with idiopathic macular hole, reductions in first-order mfERG responses are limited to the central macula, while the second-order mfERG response abnormalities involved more of the peripheral macular region. OCT measurement of apical and not the basal diameter of macular hole correlated with the severity of retinal dysfunction assessed by both mfERG and visual acuity.

Manganese superoxide dismutase and chemokine genes polymorphisms in chinese patients with anterior uveitis.

PURPOSE: To investigate the association of single-nucleotide polymorphisms (SNPs) in the manganese superoxide dismutase (MnSOD) and two chemokine genes (CCL2 and CCL5) in patients with anterior uveitis (AU). METHODS: Seventy-nine Chinese patients with acute AU were recruited, and genotyping of four SNPs including MnSOD 47, CCL2 -2518, CCL2 -2076, and CCL5 -403 alleles was performed with SNP genotyping assays. The genotype and allele frequencies were compared between patients with AU and 206 healthy control subjects. Analyses were also stratified according to the HLA-B27 status of the patients. RESULTS: There were significant increases in the frequency of the AA homozygosity in the MnSOD 47 SNP (P = 0.049) and in the CCL2 -2518G allele frequency and GG homozygosity in patients with AU compared with control subjects (P = 0.017 and P = 0.024, respectively). No significant association was found between AU with the CCL2 -2076 and CCL5 -403 SNPs. Subgroup analyses showed that the MnSOD 47A polymorphism was significantly associated with AU in HLA-B27-positive patients, but not in HLA-B27-negative patients, whereas the CCL2 -2518G polymorphism was significantly associated with AU in HLA-B27-negative patients, but not in HLA-B27-positive patients. CONCLUSIONS: The 47A polymorphism in the MnSOD gene and the -2518G polymorphism in the CCL2 gene are associated with the development of AU in HLA-B27-positive and -negative Chinese patients, respectively. Further studies to evaluate the interactions of the HLA-B27 status and these SNPs are warranted.

First and second-order kernel multifocal electroretinography abnormalities in acute central serous chorioretinopathy.

PURPOSE: To evaluate the first and second-order kernel multifocal electroretinogram (mfERG) response abnormalities in patients with acute central serous chorioretinopathy (CSC). METHODS: This was a cross-sectional observational study in which 45 eyes of 45 patients with acute CSC underwent mfERG recordings. Peak amplitudes and implicit times of the first and second-order kernel responses were analyzed and compared with 20 age-matched normal controls. Correlation analyses were performed between the patients' visual acuity and the first and second-order amplitudes and implicit times. RESULTS: The first-order N1 and P1 mfERG amplitudes in the central three concentric rings were reduced in eyes with acute CSC compared with controls (P < 0.05). The first-order P1 implicit times of the central four rings were also delayed (P < 0.05). For the second-order mfERG response, there were significant reductions in the second-order P1 and N1 amplitudes in rings 3-5 compared with controls (P < 0.05). No significant difference between the second-order P1 and N1 implicit times was found compared with controls (P > 0.05). Correlation analyses showed significant correlations between visual acuity and the first-order N1 response amplitudes of rings 1 and 2, and for the first-order N1 and P1 implicit times of rings 1-4 (P < 0.05). CONCLUSION: Both first and second-order mfERG response abnormalities occur in eyes with acute CSC. These results suggest that in acute CSC, while outer retinal dysfunction is mostly localized to the central macula, there might be more widespread impairment in adaptive mechanisms of the inner retina or outer plexiform layer dysfunction in the more peripheral macula.

Genotype phenotype analysis of Bietti's crystalline dystrophy in patients with CYP4V2 mutations.

PURPOSE: To evaluate the genotypic and phenotypic correlations of Bietti's crystalline dystrophy (BCD) in patients with the CYP4V2 gene by mutation screening and clinical and electrophysiological assessment. METHODS: Eighteen Chinese patients in 13 families with BCD were recruited for full ophthalmic examinations, optical coherence tomography (OCT), and visual electrophysiological tests, including electrooculography (EOG), full-field electroretinography (ERG), and multifocal electroretinography (mfERG). Peripheral venous blood was obtained from all index patients and their family members for genomic DNA extraction and CYP4V2 sequence screening by direct sequencing. RESULTS: All 18 patients with BCD had mutations in the CYP4V2 gene: five were novel (Y219H, W244X, D324V, P396L, and R400C) and four had been reported. A common mutation occurred at the splice site IVS6-8del17bp/insGC of 12 patients, four being homozygous. OCT showed the presence of intraretinal crystals in all patients. Patients with more severe thinning of the retina had worse visual acuity, and there was moderate correlation between the OCT central foveal thickness and visual acuity (Spearman rho = 0.46, P = 0.005). Patients with splice site mutations (i.e., homozygous IVS6-8del17bp/insGC or compound heterozygous IVS6-8del17bp/insGC and IVS8-2A>G) had lower EOG Arden index (P = 0.014) and were more likely to have a nonrecordable scotopic full-field ERG (P = 0.003) and nonrecordable 30-Hz flicker ERG (P = 0.043). CONCLUSIONS: BCD patients with homozygous IVS6-8del17bp/insGC or compound heterozygous IVS6-8del17bp/insGC and IVS8-2A>G mutations appeared to have more severe disease phenotype based on electrophysiological testing. The level of visual loss in BCD is related to the severity of retinal thinning.

The clinical applications of multifocal electroretinography: a systematic review.

Multifocal electroretinography (mfERG) is an investigation that can simultaneously measure multiple electroretinographic responses at different retinal locations by cross-correlation techniques. mfERG therefore allows topographic mapping of retinal function in the central 40-50 degrees of the retina. The strength of mfERG lies in its ability to provide objective assessment of the central retinal function at different retinal areas within a short duration of time. Since the introduction of mfERG in 1992, mfERG has been applied in a large variety of clinical settings. This article reviews the clinical applications of mfERG based on the currently available evidence. mfERG has been found to be useful in the assessment of localized retinal dysfunction caused by various acquired or hereditary retinal disorders. The use of mfERG also enabled clinicians to objectively monitor the treatment outcomes as the changes in visual functions might not be reflected by subjective methods of assessment. By changing the stimulus, recording, and analysis parameters, investigation of specific retinal electrophysiological components can be performed topographically. Further developments and consolidations of these parameters will likely broaden the use of mfERG in the clinical setting.

Visual field and multifocal electroretinography and their correlations in patients on hydroxychloroquine therapy.

PURPOSE: To evaluate the effects of hydroxychloroquine on visual field and multifocal electroretinography (mfERG) and their correlations in patients taking hydroxychloroquine. METHODS: This was a cross-sectional study in which patients on hydroxychloroquine therapy underwent automated 10-2 threshold static visual field examination and mfERG recordings. Non-parametric unadjusted and age-adjusted Spearman correlation coefficients rho were calculated between the cumulative dose of hydroxychloroquine and the visual field mean deviation (MD) and pattern standard deviation (PSD) values; and the mfERG response amplitudes and peak latencies. Correlation analysis was also performed between the visual field MD and PSD values and the mfERG response amplitudes and peak latencies. RESULTS: A total of 26 eyes in 13 patients were analyzed. The mean duration of hydroxychloroquine therapy was 4.9 years and the mean cumulative dose was 574 g. No significant correlation was found between the cumulative dose of hydroxychloroquine and the visual field MD and PSD values. There were significant correlations between the cumulative dose of hydroxychloroquine and mfERG N1 and P1 response amplitudes for the central rings (ring 1-3). The correlations between the dose of hydroxychloroquine and mfERG N1 and P1 response amplitudes were strongest for the paracentral ring 2 (rho =-0.63 and rho =-0.62, respectively, P = 0.001). Significant correlations were also found between the visual field MD values and mfERG response amplitudes of various ring eccentricities. CONCLUSIONS: In patients on hydroxychloroquine, mfERG response amplitude correlated with both the 10-2 visual field MD values and with the cumulative dose of hydroxychloroquine used. The use of mfERG can provide objective measurement of retinal function in patients on hydroxychloroquine and may provide supplementary quantitative information to visual field findings.