Internal Limiting Membrane Peeling and Inverted Flap Technique in Macular Hole: Postoperative Metamorphopsia and Optical Coherence Tomography.

INTRODUCTION: We compared postoperative metamorphopsia and optical coherence tomography (OCT) findings between eyes that underwent internal limiting membrane (ILM) peeling and the inverted flap (IF) technique for macular hole (MH). METHODS: This retrospective analysis included 64 eyes of 64 patients with idiopathic MH whose MH was closed after initial surgery. Thirty-nine patients were treated with pars plana vitrectomy (PPV) with ILM peeling, and 25 patients were treated with PPV with the IF technique. Best corrected visual acuity (BCVA), severity of metamorphopsia, and OCT images were collected before and 3, 6, and 12 months postoperatively. Based on the OCT images, the status of the external limiting membrane (ELM) and ellipsoid zone and the presence of hyperreflective plugs were assessed. RESULTS: At baseline and 3, 6, and 12 months postoperatively, BCVA and severity of metamorphopsia were not significantly different between groups. The status of the ELM was significantly worse in the IF group than in the ILM peeling group at 3 and 6 months postoperatively. Significantly more hyperreflective plugs were observed in the IF group than in the ILM peeling group at 3 and 6 months postoperatively. Stepwise multiregression analysis revealed that hyperreflective plugs were significantly associated with the severity of metamorphopsia at 12 months postoperatively. DISCUSSION/CONCLUSION: The alterations on the OCT were fewer in the ILM peeling group than in the IF group, while no significant differences were observed in postoperative severity of metamorphopsia between groups. Metamorphopsia was worse in eyes with hyperreflective plugs.

A novel de-novo RB1 mutation identified in a patient with bilateral retinoblastoma.

Retinoblastoma manifests as ocular malignancy due to mutations in the RB1 gene. A 17-month-old girl with bilateral retinoblastoma having no family history was admitted to our hospital. The right eye was enucleated but the other was preserved with systemic chemotherapy and topical treatment. The patient has been tumor-free for over 7 years since diagnosis. All exons of RB1 were sequenced and a novel 1-base pair deletion (NM_000321.2:c.2409del, p.Asn803Lysfs*7) was detected.

Multifocal Contact Lenses and 0.01% Atropine Eye Drops for Myopia Control Study: Research Protocol for a 1-Year, Randomized, Four-Arm, Clinical Trial in Schoolchildren.

OBJECTIVES: Previous studies have shown that combined use of orthokeratology and 0.01% atropine (AT) eye drops can strongly prevent axial elongation in myopic children. However, the efficacy of combined use with multifocal contact lens (MFCL) and 0.01% AT remains unclear. The aim of this trial is to clarify the efficacy of MFCL+0.01% AT combination therapy for myopia control and safety. METHODS: This prospective study is a randomized, double-masked, placebo-controlled trial with four arms. A total of 240 children aged 6 to 12 years with myopia is recruited and randomly assigned to one of the four groups in a ratio of 1:1:1:1 as follows: group 1: MFCL+AT combination therapy, group 2: MFCL monotherapy, group 3: AT monotherapy, and group 4: placebo. The participants will continue the assigned treatment for 1 year. The primary and secondary outcomes are the comparisons of axial elongation and myopia progression in the four groups during the 1-year study period. DISCUSSION: The present trial would determine whether the MFCL+AT combination therapy is more effective in slowing axial elongation and myopia progression in schoolchildren as compared with each monotherapy or placebo, and it also confirm acceptable safety of the combination therapy.

Myopia Control With Orthokeratology: A Review.

ABSTRACT: A number of studies regarding the effect of orthokeratology (OK) on myopia progression have been published and shown that it can slow myopia progression in school-aged children. Recently, OK has been considered to be one of the most effective optical treatments for myopia control. This article reviewed the peer-reviewed literature on the efficacy of OK for myopia control. Although it cannot halt myopia progression completely, the inhibitory effect on axial elongation for 2 years has been reported to be from 32% to 63%, as compared with single-vision spectacles and contact lenses. In addition, the efficacy and acceptable safety have been confirmed even in several long-term studies up to 10 years. However, the possibility of a rebound phenomenon in myopia progression after OK discontinuation remains unknown. It is also unclear how long the treatment should be continued to attain the maximum benefit in each patient. In the near future, further research including assessment of rebound phenomenon should be conducted with longer follow-up periods in more diverse populations.

Preoperative aniseikonia is a prognostic factor for postoperative stereopsis in patients with unilateral epiretinal membrane.

PURPOSE: To investigate stereopsis and other visual functions in patients with unilateral epiretinal membrane (ERM) and to identify vision-related parameters affecting stereopsis. METHODS: This prospective study included 63 consecutive patients who were scheduled to undergo vitrectomy for unilateral idiopathic ERM. We examined stereopsis (Titmus Stereo Test, TST; TNO stereotest, TNO), best-corrected visual acuity (BCVA), letter contrast sensitivity, severity of metamorphopsia, and degree of aniseikonia preoperatively and 6 months postoperatively. RESULTS: Preoperatively, we observed significant correlation between TST scores and other vision-related parameters except severity of metamorphopsia and between TNO score and all the vision-related parameters. Multiple regression analysis showed that preoperative TST and TNO scores were significantly associated with the degree of aniseikonia (both P < 0.01). ERM surgery significantly improved stereopsis, BCVA, contrast sensitivity, and metamorphopsia, but not aniseikonia. Postoperatively, TST was significantly associated with BCVA, and TNO showed association with BCVA and aniseikonia. Postoperative TST and TNO scores showed significant correlation with preoperative aniseikonia (P < 0.005 and P < 0.001, respectively). CONCLUSIONS: Impairment of stereopsis in patients with unilateral ERM was considered to be due to retinally induced aniseikonia. Aniseikonia did not improve by surgery, and preoperative aniseikonia can be a prognostic factor for postoperative stereopsis.

CHANGES IN METAMORPHOPSIA AND OPTICAL COHERENCE TOMOGRAPHY FINDINGS AFTER SUCCESSFUL RETINAL DETACHMENT SURGERY.

PURPOSE: To investigate changes in metamorphopsia after rhegmatogenous retinal detachment surgery and to evaluate the relationship between metamorphopsia and retinal microstructures assessed with optical coherence tomography. METHODS: The study included 47 eyes of 47 patients undergoing retinal detachment surgery. We examined the severity of metamorphopsia using M-CHARTS, best-corrected visual acuity, and optical coherence tomography images. All data were recorded before and 3, 6, and 12 months after surgery, except for M-CHARTS which were recorded only postoperatively. RESULTS: Metamorphopsia scores at 3, 6, and 12 months postoperatively were 0.46 ± 0.51, 0.41 ± 0.44, and 0.28 ± 0.37, respectively, with significant improvement from 3 months to 12 months after surgery. Significant metamorphopsia (score ≥0.2) was present in 49% of patients at 12 months postoperatively. Multiple regression analysis revealed that metamorphopsia score at 12 months was significantly related to the status of macula and interdigitation zone. In patients with macula-off retinal detachment, improvement of metamorphopsia scores was associated with an increase in thickness of external limiting membrane-retinal pigment epithelium. CONCLUSION: After successful retinal detachment surgery, metamorphopsia gradually improved, but nearly half of the patients still exhibited metamorphopsia at 12 months postoperatively. Disruption of interdigitation zone and external limiting membrane-retinal pigment epithelium thickness was related to metamorphopsia.

TIME COURSE OF CHANGES IN METAMORPHOPSIA FOLLOWING INTRAVITREAL RANIBIZUMAB INJECTION FOR BRANCH RETINAL VEIN OCCLUSION.

PURPOSE: To evaluate the effects of intravitreal ranibizumab injection (IVR) on metamorphopsia in patients with branch retinal vein occlusion (BRVO) and to assess the relationship between retinal microstructure and metamorphopsia. METHODS: Subjects were 39 eyes of 39 patients with branch retinal vein occlusion. The severity of metamorphopsia was quantified using the M-CHARTS before and 1, 2, 3, 4, 5, and 6 months after treatment. Based on optical coherence tomography (OCT) images, we assessed central retinal thickness (CRT) and status of the external limiting membrane (ELM) and ellipsoid zone (EZ). The association between retinal microstructure and metamorphopsia was analyzed in 24 eyes with treatment-naïve branch retinal vein occlusion. RESULTS: Intravitreal ranibizumab injection treatment significantly improved best-corrected visual acuity (BCVA) and central retinal thickness (P < 0.0001, P < 0.0001, respectively), but metamorphopsia did not improve by treatment. Posttreatment metamorphopsia scores showed a significant correlation with duration of symptoms (P < 0.05) and pretreatment metamorphopsia scores (P < 0.01). Posttreatment metamorphopsia score was significantly worse in patients with disruption of external limiting membrane (P < 0.05). CONCLUSIONS: In patients with branch retinal vein occlusion, intravitreal ranibizumab injection treatment significantly improved best-corrected visual acuity and central retinal thickness, but not metamorphopsia. The severity of posttreatment metamorphopsia was significantly associated with duration of symptoms, degree of pretreatment metamorphopsia, and posttreatment integrity of external limiting membrane.

Safety and efficacy following 10-years of overnight orthokeratology for myopia control.

PURPOSE: To compare rates of myopia progression and adverse events between orthokeratology (OK) and soft contact lens (SCL) wearers over a 10-year period in schoolchildren. METHODS: Medical records of consecutive patients (≤16 years of age at baseline) who started OK for myopia correction and continued the treatment for 10 years were retrospectively reviewed. For the control group, patients who started using soft contact lenses (SCLs) for myopia correction and continued to use them for 10 years were also reviewed. Clinical data, including sex, age, manifest refraction, visual acuity, prescription lens power, and adverse events during the 10-year period, were recorded. Estimated myopia progression was calculated as the sum of 'changes in prescription lens power during 10 years' and 'residual refractive errors at the 10-year visit,' and was compared between groups. We also compared the incidence of adverse events between groups over the 10-year study period. RESULTS: A total of 104 eyes of 53 patients who underwent OK treatment and 78 eyes of 39 patients who wore SCLs fulfilled the criteria. The estimated myopia progression over the 10-year period found in the OK and SCL groups were -1.26 ± 0.98 and -1.79 ± 1.24 days, respectively; this difference was statistically significant (p = 0.001). Additionally, lower myopia progression was found in the OK in comparison to the SCL group at all baseline ages (p = 0.003 to p = 0.049) except at 16 years old (p = 0.41). No significant difference was found in the number of adverse events found between the OK (119) and SCL (103) groups (p = 0.72). CONCLUSIONS: The results of this study supports the long-term efficacy and safety of OK lens wear in reducing myopia progression in schoolchildren.

Aniseikonia in various retinal disorders.

PURPOSE: The purpose was to quantify and compare the severity of aniseikonia in patients undergoing vitrectomy for various retinal disorders. METHODS: We studied 357 patients with retinal disorders including epiretinal membrane (ERM), macular hole (MH), cystoid macular edema with branch / central retinal vein occlusion (BRVO-CME / CRVO-CME), diabetic macular edema (DME), macula-off rhegmatogenous retinal detachment (M-off RD), and macula-on RD (M-on RD) as well as 31 normal controls. The amount of aniseikonia was measured using the New Aniseikonia Test preoperatively and at 6 months postoperatively. RESULTS: Of all patients, 59% presented aniseikonia. Preoperative and postoperative mean aniseikonia were 4.0 ± 4.1% and 3.0 ± 3.6%, respectively. In particular, 68% of patients with ERM had macropsia, and approximately half of MH, RVO-CME, DME, and M-off RD patients had micropsia. Preoperative aniseikonia was significantly severe in ERM than in other disorders. Vitrectomy improved aniseikonia only in MH, while visual acuity was improved in all disorders except CRVO-CME. CONCLUSION: More than half of the patients showed aniseikonia preoperatively. A majority of ERM patients exhibited macropsia, whereas MH, RVO-CME, DME, and macula-off RD patients presented micropsia. The aniseikonia score was greatest in ERM patients. In most retinal disorders, surgery significantly improved visual acuity, but not aniseikonia.

Functional visual acuity in patients with successfully treated amblyopia: a pilot study.

PURPOSE: The aim of this study was to use conventional visual acuity measurements to quantify the functional visual acuity (FVA) in eyes with successfully treated amblyopia, and to compare the findings with those for contralateral normal eyes. METHODS: Nineteen patients (7 boys, 12 girls; age 7.5 ± 2.2 years) with successfully treated unilateral amblyopia and the same conventional decimal visual acuity in both eyes (better than 1.0) were enrolled. FVA, the visual maintenance ratio (VMR), maximum and minimum visual acuity, and the average response time were recorded for both eyes of all patients using an FVA measurement system. The differences in FVA values between eyes were analyzed. RESULTS: The mean LogMAR FVA scores, VMR (p < 0.001 for both), and the LogMAR maximum (p < 0.005) and minimum visual acuity (p < 0.001) were significantly poorer for the eyes with treated amblyopia than for the contralateral normal eyes. There was no significant difference in the average response time. CONCLUSIONS: Our results indicate that FVA and VMR were poorer for eyes with treated amblyopia than for normal eyes, even though the treatment for amblyopia was considered successful on the basis of conventional visual acuity measurements. These results suggest that visual function is impaired in eyes with amblyopia, regardless of treatment success, and that FVA measurements can provide highly valuable diagnosis and treatment information that is not readily provided by conventional visual acuity measurements.

RELATIONSHIP BETWEEN METAMORPHOPSIA AND INTRARETINAL CYSTS WITHIN THE FLUID CUFF AFTER SURGERY FOR IDIOPATHIC MACULAR HOLE.

PURPOSE: To quantify metamorphopsia in patients undergoing vitrectomy for idiopathic macular hole (MH) and to investigate the relationship between metamorphopsia and foveal microstructure. METHODS: This is prospective, consecutive, interventional study. Fifty-one eyes of MH were included. Severity of metamorphopsia was quantified using the M-CHARTS and foveal microstructure was assessed with optical coherence tomography preoperatively and at 3 months, 6 months postoperatively. Based on the optical coherence tomography images, the authors quantified minimum and base diameters of MH, macular thickness, defect lengths of external limiting membrane, ellipsoid zone and interdigitation zone, and the area of intraretinal cysts within the fluid cuff. RESULTS: Mean metamorphopsia score was significantly improved from 0.82 to 0.44. Postoperative mean and horizontal metamorphopsia scores were correlated with preoperative base diameters of MH, defect lengths of external limiting membrane, and the area of cysts in fluid cuff. Multiple regression analysis revealed that postoperative mean and horizontal metamorphopsia scores were significantly positively relevant to the area of intraretinal cysts within the fluid cuff. Postoperative vertical metamorphopsia score was also correlated with the area of intraretinal cysts within the fluid cuff. CONCLUSION: Vitrectomy for MH improved metamorphopsia. Postoperative metamorphopsia was associated with the preoperative area of intraretinal cysts within the fluid cuff.

Aniseikonia and Foveal Microstructure in Patients with Idiopathic Macular Hole.

PURPOSE: To quantify the severity of aniseikonia in patients undergoing vitrectomy for idiopathic macular hole (MH) and to examine any relationship between aniseikonia and the foveal microstructure. DESIGN: Prospective, consecutive, interventional case series. PARTICIPANTS: We included 56 eyes of 56 patients who underwent vitrectomy to treat idiopathic MH. METHODS: We examined visual acuity, aniseikonia using the New Aniseikonia Test, and foveal structure using optical coherence tomography (OCT) before and 3, 6, and 12 months after surgery. Based on OCT images, minimum and base diameters of MH, height of MH, and defect lengths of the external limiting membrane (ELM), ellipsoid zone, and interdigitation zone were assessed. MAIN OUTCOME MEASURES: Degree of aniseikonia before and after surgery. RESULTS: The mean aniseikonia was -3.2±4.6%, ranging from -15.5% to +5.0%. Of the patients, 55% had micropsia, 7% had macropsia, and 38% had no aniseikonia. The mean absolute value of aniseikonia improved significantly from 3.8±4.1% before surgery to 1.0±1.5% at 12 months after surgery (P < 0.0001). The preoperative mean absolute value of aniseikonia showed a significant correlation with minimum diameters of MH (P < 0.01), base diameters of MH (P < 0.01), and the defect length of ELM (P < 0.05). In multivariate analysis, preoperative aniseikonia showed a significant correlation with the defect length of ELM (P < 0.05). In contrast, postoperative aniseikonia was not associated with any of the parameters. CONCLUSIONS: Approximately half of MH patients had micropsia. Vitrectomy for MH improved aniseikonia. Preoperative aniseikonia was associated with MH size and the defect length of ELM.

Relationship between metamorphopsia and foveal microstructure in patients with branch retinal vein occlusion and cystoid macular edema.

PURPOSE: We aimed to investigate the relationship between the severity of metamorphopsia and the foveal microstructure measured with spectral-domain optical coherence tomography (SD-OCT) in patients with cystoid macular edema caused by branch retinal vein occlusion (BRVO-CME). METHODS: The study included 30 eyes of 30 patients with BRVO-CME. We examined visual acuity and the severity of metamorphopsia using M-CHARTS. Central foveal thickness, central retinal thickness at the fovea (CRT-1 mm), and macular volume were measured with SD-OCT software. The status of ellipsoid zone (EZ), external limiting membrane (ELM), outer retinal cyst, and inner retinal cyst was also evaluated. RESULTS: The mean metamorphopsia score was 0.77 ± 0.50, with 28 of 30 patients (93 %) having metamorphopsia (metamorphopsia score ≥ 0.2). The vertical metamorphopsia score (0.89 ± 0.54) was significantly higher than the horizontal metamorphopsia score (0.64 ± 0.53) (p < 0.005). The status of EZ and ELM was significantly associated with visual acuity, but not with the mean metamorphopsia score. The mean metamorphopsia score was significantly related to CRT-1 mm (p < 0.05) and the presence of inner retinal cyst (p < 0.05). CONCLUSIONS: The severity of metamorphopsia was significantly associated with central retinal thickness and the presence of inner retinal cyst.

Influence of posterior corneal astigmatism on postoperative refractive astigmatism in pseudophakic eyes after cataract surgery.

BACKGROUND: To examine the influence of posterior corneal astigmatism on postoperative refractive astigmatism in pseudophakic eyes after cataract surgery. METHODS: The study enrolled 64 pseudophakic eyes of 50 patients (71.8 ± 9.9 years old, mean ± standard deviation) who had undergone phacoemulsification with non-toric IOL implantation. Refractive astigmatism was measured using an auto ref-keratometer with a 0.01- diopter (D) scale. Two types of corneal astigmatism were calculated using anterior segment optical coherence tomography; keratometric and total corneal astigmatism. Keratometric astigmatism was obtained based on anterior corneal curvature alone and total corneal astigmatism was calculated using both anterior and posterior corneal curvatures. The difference between refractive and corneal astigmatism was computed as the vector difference using 1) refractive and keratometric astigmatism and 2) refractive and total corneal astigmatism. RESULTS: The mean refractive, keratometric, and total corneal astigmatism was 0.92 ± 0.48 D, 0.87 ± 0.44 D, and 0.94 ± 0.46 D, respectively. The difference between refractive and keratometric astigmatism (0.70 ± 0.40 D, mean vector of 0.30 D axis 164°) was significantly larger than the difference between refractive and total corneal astigmatism (0.63 ± 0.38 D, mean vector of 0.12 D axis 137°) (P = .019). CONCLUSIONS: The difference between refractive and total corneal astigmatism, calculated using both anterior and posterior corneal curvatures, was significantly smaller than the difference between refractive and keratometric astigmatism using anterior corneal astigmatism alone, implying that the latter overestimates the true postoperative refractive astigmatism and can cause cylindrical inaccuracy after cataract surgery.

Influence of ocular wavefront aberrations on axial length elongation in myopic children treated with overnight orthokeratology.

PURPOSE: To determine ocular optical parameters that affect axial length elongation in myopic children undergoing overnight orthokeratology. DESIGN: Prospective, noncomparative study. PARTICIPANTS: Fifty-nine subjects who met the inclusion criteria were enrolled in this study. METHODS: Axial length and ocular wavefront aberration were assessed before and 1 year after the start of orthokeratology. Corneal topography was performed, and then corneal multifocality was calculated for a 4-mm pupil. After evaluating simple correlations between axial elongation and optical parameters, multiple linear regression analysis was performed to identify explanatory variables with a statistically significant contribution to axial elongation. MAIN OUTCOME MEASURES: Axial length and ocular wavefront aberration before and 1 year after the start of orthokeratology. RESULTS: Fifty-five subjects completed the 1-year follow-up examinations. At baseline, their age ranged from 7.2 to 12.0 years. The manifest spherical equivalent refractive error ranged from -3.50 to -0.75 diopters. The mean axial length significantly increased from 24.20 mm at baseline to 24.43 mm 1 year after treatment. The axial elongation showed significant simple correlations with the change in C2(0), change in second-order aberration, change in coma-like aberration, change in spherical-like aberration, change in total higher-order aberrations, change in corneal multifocality, baseline age, and baseline spherical equivalent refractive error, but not C4(0). Multiple linear regression analysis showed that the change in coma-like aberration was the most relevant variable. CONCLUSIONS: Asymmetric corneal shapes, rather than concentric and radially symmetric shapes, have a considerable effect on retardation of axial elongation, suggesting that the inhibitory effect of orthokeratology on myopia progression is caused by mechanisms other than the reduction in peripheral hyperopic defocus.

Corneal thickness profile and posterior corneal astigmatism in normal corneas.

PURPOSE: To analyze the influence of corneal thickness profile on posterior corneal astigmatism (PA). DESIGN: Prospective, observational study. SUBJECTS: We included 418 normal subjects (213 men and 205 women) ranging in age from 6 to 93 years (49.0 ± 23.4 years, mean ± standard deviation) in this study. METHODS: Anterior and posterior corneal topography were evaluated using 3-dimensional anterior segment optical coherence tomography. Pericentral corneal thickness (PCT) in each quadrant (superior, inferior, nasal, and temporal) was measured, and average PCT in the vertical (superior + inferior) and horizontal (nasal + temporal) directions was calculated. Posterior corneal astigmatism was calculated as (1) assumed PA based on the anterior corneal curvature measurement and the keratometric index and (2) actual PA derived from the direct measurement of posterior corneal curvature. MAIN OUTCOME MEASURES: Corneal thickness distribution and the difference between assumed and actual PA. RESULTS: The PCT was significantly greater in the vertical (546.0 ± 31.8 µm) than in the horizontal direction (542.6 ± 31.7 µm) (P < 0.0001), and the difference between them was significantly correlated with subject age (r = 0.518, P < 0.0001). The difference between assumed and actual PA significantly correlated with the discrepancy between vertical and horizontal PCT (r = 0.819, P < 0.0001), as well as subject age (r = 0.533, P < 0.0001). CONCLUSIONS: Corneal thickness is greater in the vertical than in the horizontal direction, making the PA more against-the-rule pattern than calculated on the basis of the anterior corneal curvature measurement only. Such discrepancy is more prominent in older patients.

INNER NUCLEAR LAYER THICKNESS AS A PROGNOSTIC FACTOR FOR METAMORPHOPSIA AFTER EPIRETINAL MEMBRANE SURGERY.

PURPOSE: To evaluate prognostic factors for metamorphopsia in patients undergoing vitrectomy for epiretinal membrane using spectral domain optical coherence tomography. METHODS: This study included 53 eyes of 53 patients undergoing vitrectomy for idiopathic epiretinal membrane. The authors examined visual acuity, severity of metamorphopsia with M-CHARTS, and retinal microstructures with spectral domain optical coherence tomography before surgery and 3 months and 6 months after surgery. Central foveal thickness, parafoveal retinal thickness, macular volume, thickness of the ganglion cell layer, inner nuclear layer, and outer retinal layer (ONL + OPL: outer nuclear layer and outer plexiform layer) were analyzed using an image processing program. The status of the outer retinal lines was also evaluated. RESULTS: Preoperative metamorphopsia score (M-score) significantly correlated with central foveal thickness, inner nuclear layer thickness, and ONL + OPL thickness. Postoperative M-score significantly correlated with postoperative central foveal thickness and inner nuclear layer thickness. Inner nuclear layer thickness had significant correlation with M-score at each time point by multiple regression analysis, whereas other parameters were not relevant. Multiple regression analysis showed that preoperative inner nuclear layer thickness yielded the highest regression coefficient with postoperative M-score. CONCLUSION: Inner nuclear layer thickness was found to be a good indicator of metamorphopsia both before and after surgery and a predictor of postoperative metamorphopsia in patients with epiretinal membrane.

STEREOPSIS AND OPTICAL COHERENCE TOMOGRAPHY FINDINGS AFTER EPIRETINAL MEMBRANE SURGERY.

PURPOSE: To evaluate stereopsis in patients undergoing vitrectomy for epiretinal membrane and to investigate the relationship between stereopsis and foveal microstructures. METHODS: This study included 55 eyes of 55 patients who underwent vitrectomy for unilateral epiretinal membrane and 27 age-matched normal subjects. We examined stereopsis using the Titmus Stereo Test, TNO stereotest, and, optical coherence tomography before surgery and 6 months after surgery. Central foveal thickness, central retinal thickness at the parafovea (CRT-3 mm), macular volume, and retinal layer thickness were measured with the optical coherence tomography software and an image-processing program. RESULTS: Epiretinal membrane surgery significantly improved stereopsis in Titmus Stereo Test and in TNO. Stereopsis after surgery was significantly worse than in normal subjects. In stepwise multiple regression analysis, preoperative stereopsis showed a significant association with preoperative CRT-3 mm. Postoperative stereopsis was significantly correlated with postoperative inner nuclear layer thickness. Postoperative Titmus Stereo Test and TNO were significantly related to preoperative CRT-3 mm and preoperative macular volume and inner nuclear layer thickness, respectively. CONCLUSION: Vitrectomy for epiretinal membrane improved stereopsis, albeit not to a normal level. Titmus Stereo Test, a stereotest with a smaller index, was related to CRT-3 mm, whereas TNO with a larger index was correlated with retinal volume of the entire posterior pole and mean inner nuclear layer thickness.

Time course of changes in aniseikonia and foveal microstructure after vitrectomy for epiretinal membrane.

PURPOSE: To quantify aniseikonia in patients undergoing vitrectomy for epiretinal membrane (ERM) and to investigate the relationship between the aniseikonia and the foveal microstructure by spectral-domain (SD) optical coherence tomography (OCT). DESIGN: Prospective, consecutive, interventional case series. SUBJECTS: This study included 44 eyes of 44 patients undergoing vitrectomy for idiopathic ERM. METHODS: We examined visual acuity and aniseikonia using the New Aniseikonia Test and SD-OCT before and 3 and 6 months after surgery. On the basis of the obtained OCT image, we divided the 1.0 × 1.0-mm area centered on the fovea into 9 sections at 0.25-mm intervals and quantified the following parameters using an image-processing program: central foveal thickness and mean thickness of the ganglion cell layer, inner nuclear layer (INL), and outer retinal layer (outer nuclear layer + outer plexiform layer). The status of the photoreceptor inner segment/outer segment junction, external limiting membrane, and cone outer segment tips also was evaluated. MAIN OUTCOME MEASURES: Amount of aniseikonia 6 months after surgery. RESULTS: Of 44 patients, 39 (89%) had macropsia, 1 (2%) had micropsia, and 4 (9%) had no aniseikonia preoperatively. Mean preoperative aniseikonia was 6.2% ± 4.5%. Vitrectomy significantly improved visual acuity in patients with ERM but did not change the amount of aniseikonia. Multiple regression analysis revealed that preoperative aniseikonia at 6 months was significantly related to preoperative INL thickness, whereas postoperative aniseikonia at 6 months was associated with postoperative INL thickness at 6 months. Preoperative INL thickness was found to be of significant prognostic value for postoperative aniseikonia at 6 months. CONCLUSIONS: Most of the patients with ERM had macropsia. Aniseikonia was not reduced after surgery. The amount of aniseikonia was associated with INL thickness.

Age-related changes in anterior, posterior, and total corneal astigmatism.

PURPOSE: To evaluate age-related changes in anterior, posterior, and total corneal astigmatism by comparing simulated keratometric astigmatism to total corneal astigmatism. METHODS: Corneal topography of the anterior and posterior surfaces was evaluated using three-dimensional optical coherence tomography in 419 patients with normal eyes (218 men and 201 women) with ages ranging from 8 to 93 years (mean ± standard deviation: 49.5 ± 23.1 years). Keratometric astigmatism was calculated using the keratometric index (1.3375) and radius of the anterior corneal curvature; anterior and posterior corneal curvature measurements were used to calculate total corneal astigmatism. RESULTS: The keratometric and total astigmatism were 1.08 ± 0.71 diopters (D) and 1.03 ± 0.69 D, respectively. Vector analysis revealed a mean difference between keratometric and total astigmatism of 0.24 ± 0.09 D, which showed a significant correlation to age (P < .0001). In eyes with with-the-rule astigmatism, keratometric astigmatism overestimated total astigmatism. In eyes with against-the-rule astigmatism, keratometric astigmatism underestimated total astigmatism. CONCLUSIONS: The anterior corneal surface shifts from with-the-rule to against-the-rule astigmatism with aging, whereas the posterior corneal surface remains as against-the-rule astigmatism in most cases. The variation in the anterior astigmatism is the most important factor contributing to this change. Total corneal astigmatism is a better predictor than keratometric astigmatism for selecting toric intraocular lenses.