Microperimetry assessment in foveal hypoplasia: functional results in a series of pediatric patients.

OBJECTIVE: To study the relationships of functional and morphologic retinal parameters in a series of pediatric patients with varying degrees of foveal hypoplasia (FH). DESIGN: Monocentric observational retrospective study. PARTICIPANTS: Among 21 pediatric patients, 16 met inclusion criteria, having FH confirmed with spectral-domain optical coherence tomography (SD-OCT) scan METHODS: Data were analyzed retrospectively. Patients able to undergo macular microperimetry (MP) and SD-OCT examinations were included in the analysis. MP and SD-OCT outcomes were compared with FH grading and best-corrected visual acuity (BCVA) using Pearson's correlation. RESULTS: Thirty-one eyes from 16 patients (mean age 12.4 years) with different degrees of FH were analyzed. Two patients had grade 1, 7 had grade 2, 5 had grade 3, and 2 had grade 4 FH. Clinical nystagmus was present in 8 patients. The correlation between BCVA and SD-OCT data (-0.31) was lower than that found between BCVA and nystagmus (0.64), that for fixation index P1 (-0.60), as well as that for macular sensitivity (-0.63). CONCLUSIONS: Although limited by the small sample, our study confirms the feasibility of automated MP evaluation in pediatric patients with FH. The added value of this work is the provision of data on relationships between anatomic and functional macular measurements acquired with SD-OCT, MP, and BCVA in eyes with various degrees of FH. Larger prospective studies are necessary to confirm these results.

Mesenchymal stem cell surgery, rescue and regeneration in retinitis pigmentosa: clinical and rehabilitative prognostic aspects.

PURPOSE: To assess whether treatment with the Limoli Retinal Restoration Technique (LRRT) can be performed in patients with retinitis pigmentosa (RP), grafting the autologous cells in a deep scleral pocket above the choroid of each eye to exert their beneficial effect on the residual retinal cells. METHODS: The patients were subjected to a complete ophthalmological examination, including best corrected visual acuity (BCVA), close-up visus measurements, spectral domain-optical coherence tomography (SD-OCT), microperimetry (MY), and electroretinography (ERG). Furthermore, the complete ophthalmological examination was carried out at baseline (T0) and at 6 months (T180) after surgery. The Shapiro-Wilk test was used to assess the normality of distribution of the investigated parameters. A mixed linear regression model was used to analyse the difference in all the studied parameters at T0 and T180, and to compare the mean change between the two groups. All statistical analyses were performed with STATA 14.0 (Collage Station, Texas, USA). RESULTS: LRRT treatment was performed in 34 eyes of 25 RP patients recruited for the study. The eyes were classified in two groups on the basis of foveal thickness (FT) assessed by SD-OCT: 14 eyes in Group A (FT≤190µm) and the remaining 20 ones in Group B (FT > 190µm). Although it had not reached the statistical significance, Group B showed a better improvement in BCVA, residual close-up visus and sensitivity than Group A. CONCLUSIONS: Previous studies have described the role of LRRT in slowing down retinal degenerative diseases. Consequently, this surgical procedure could improve the clinical and rehabilitative prognostic parameters in RP patients. On the other hand, further clinical research and studies with longer follow-up will be needed to evaluate its efficacy.

Bilateral eccentric vision training on pseudovitelliform dystrophy with microperimetry biofeedback.

Low vision patients with eccentric viewing (EV) use extrafoveal retinal areas to compensate for the loss of central vision. Such retinal loci are known as the preferred retinal locus (PRL). It is known that EV is accompanied by unstable fixation. Microperimetry systems with biofeedback training have been used as a rehabilitation aid to improve fixation stability in EV patients. Normally, only the best or dominant eye is selected for such rehabilitation. This case report describes the rehabilitation on both eyes by means of PRL relocation with MAIA microperimetry (Centervue, Padova, Italy) with biofeedback training technology of a 74-year-old woman diagnosed with adult pseudovitelliform dystrophy. The patient presented binocularly similar anatomical and functional characteristics with the PRL located over the dystrophic area. At the end of the 3 months rehabilitation period, the PRL was successfully relocated inferiorly from the fovea showing relevant visual acuity improvement.

Preferred retinal locus profile during prolonged fixation attempts.

OBJECTIVE: The retinal area or location used during any fixation attempt defines the preferred retinal locus (PRL). It is presumed that during prolonged fixation attempts there may be various representative reference points within the PRL area. This study aims to clarify this presumption. DESIGN: Prospective, nonrandomized, observational case series. PARTICIPANTS: Sixty-five eyes of 41 patients from the University of Nottingham, Queen's Medical Centre Retina and Low Vision Clinics. METHODS: A total of 65 eyes of 41 patients from the University of Nottingham, Queen's Medical Centre Retina and Low Vision Clinics were assessed for PRL using the Macular Integrity Assessment (MAIA) microperimetry equipment (CenterVue, Padova, Italy). The MAIA allows automatic calculation for 2 points named PRL_initial (PRLi), which is calculated after the first 10 seconds of fixation, and PRL_final (PRLf), which is calculated after the completion of all fixation attempts during the microperimetry test. RESULTS: Estimates of PRLi and PRLf were produced for all patients. Forty-six (71%) eyes were classified as having stable fixation; 40 of the 46 eyes (87%) had both PRLs location over the fovea centralis. Nineteen of 65 eyes (29%) were classified as having unstable or relatively unstable fixation; different PRLi and PRLf locations were found in 18 (95%) of the 19 eyes, including 13 (68%) with central geographic atrophy secondary to dry age-related macular degeneration. The mean rate of change was 5.3 units in fixation per unit change in distance in both PRLi and PRLf. CONCLUSIONS: The representative points during prolonged fixation attempts may vary at different stages of fixation. This is reflected in the characteristics of fixation stability of the patients and presents a possible association with main pathology responsible for low vision.