ONE-YEAR OUTCOMES OF METAMORPHOPSIA AND RETINAL DISPLACEMENT AFTER EPIRETINAL MEMBRANE SURGERY.

PURPOSE: To examine 1-year outcomes of metamorphopsia and tangential retinal displacement after epiretinal membrane surgery and identify predictors for metamorphopsia score at 1 year and its improvement from baseline. METHODS: M-CHARTS were used to measure metamorphopsia. Distances between the intersections of two sets of retinal vessels were measured with infrared or autofluorescence images. Predictors for metamorphopsia scores at 1 year after surgery and their differences from baseline were identified with multivariate regression analysis. RESULTS: Ninety-two eyes of 90 consecutive patients were included. The vertical and horizontal distances continued expanding for 1 year ( P < 0.001). Both vertical and horizontal metamorphopsia scores improved 3 months after surgery ( P = 0.025 and P < 0.001, respectively), and horizontal scores continued improving for a year. Horizontal metamorphopsia scores correlated with retinal displacement more strongly than vertical scores. Higher metamorphopsia score at baseline is predictive for that at 1 year. Older age and being male are predictive for less improvement of the score at 1 year from baseline. CONCLUSION: Metamorphopsia correlates with tangential retinal displacement at 1 year after epiretinal membrane surgery. Horizontal metamorphopsia scores keep improving until 1 year postoperatively. Being male and older age are both independent predictors for poor improvement of metamorphopsia after epiretinal membrane surgery.

Baseline thickness of macular ganglion cell complex predicts progression of visual field loss.

BACKGROUND: Previous studies reported that the thickness of the macular ganglion cell complex (mGCC) showed good diagnostic ability for detecting glaucoma. However, its impact on the progression of visual field loss in primary open angle glaucoma (POAG) is unknown. The purpose of this study was to assess whether baseline mGCC thickness is associated with the progression of visual field loss in POAG. METHODS: Fifty-six patients with POAG were included in the study. All patients were followed for more than 2 years after baseline optical coherence tomography (OCT) measurements. They had at least five reliable Humphrey visual field tests with 30-2 Swedish Interactive Threshold Algorithm standard tests during the follow-up period. The subjects were divided into two groups according to the slope of the mean deviation (MD): the fast progression group (MD slope < -0.4 dB/y) and the slow progression group (MD slope ≥ -0.4 dB/y). Factors compared between the groups were as follows: age, baseline intraocular pressure (IOP), mean IOP during the follow-up, refraction, baseline MD, pattern standard deviation (PSD), and baseline OCT measurements. RESULTS: There were no significant differences between the two groups in age, baseline IOP, mean IOP during the follow-up, refraction, baseline MD or PSD, average thickness of retinal nerve fiber layer (RNFL), or disc parameters. However, the baseline mGCC thickness (average and inferior hemifield) was significantly thinner in the fast progression group than in the slow progression group (74.0 ± 7.2 µm vs. 80.3 ± 8.6 µm; 68.0 ± 6.6 µm vs. 78.2 ± 11.6 µm, respectively). Moreover, global loss volume and focal loss volume, which are parameters of mGCC, showed significantly higher rates in the fast progression group than in the slow progression group. In multivariate analysis, only mGCC thickness of the inferior hemifield was associated with disease progression (P = 0.007). CONCLUSIONS: Baseline mGCC thickness can be predictive of progressive visual field loss in patients with POAG.

Effect of high myopia on glaucoma diagnostic parameters measured with optical coherence tomography.

BACKGROUND: We examined the influence of high myopia on conventional spectral-domain optical coherence tomographic parameters and assessed the macular ganglion cell complex thickness to macular outer retinal thickness ratio as a new optical coherence tomography parameter. DESIGN: Prospective cross-sectional study. PARTICIPANTS: Sixty normal and 30 highly myopic eyes (refractive error more than -6 D). METHODS: We used the RTVue-100 to measure macular ganglion cell complex and circumpapillary retinal nerve fibre layer thickness, global loss volume, and focal loss volume and then calculated the ganglion cell complex thickness to macular outer retinal thickness ratio. MAIN OUTCOME MEASURES: Each parameter was compared between the two groups. Using the area under receiver operating characteristics curve, the classification abilities of optical coherence tomography parameters were examined in highly myopic eyes. RESULTS: Between normal and highly myopic eyes, we found significant differences in ganglion cell complex and retinal nerve fibre layer thickness, global loss volume and focal loss volume. The new ratio parameter was not significantly different between groups (55.74% vs. 54.50%). The area under receiver operating characteristics curve was 0.775 (P < 0.01) for retinal nerve fibre layer thickness, 0.721 (P < 0.01) for ganglion cell complex thickness and 0.588 (P > 0.05) for the new ratio parameter. CONCLUSIONS: Although refractive status significantly affected conventional optical coherence tomography parameters, the new ratio parameter may not be influenced by refractive error. Therefore, a normative database for healthy highly myopic eyes may not be necessary if ratio parameter is used.

Aniseikonia and retinal morphological changes in eyes undergoing macular hole surgery.

Even after idiopathic macular hole (MH) surgery and with successful closure of MH, aniseikonia is a common postoperative symptom. We investigated the correlation of MH diameter, retinal displacement and retinal layer thicknesses with aniseikonia in 41 eyes of 41 patients undergoing MH surgery with internal limiting membrane peeling. Aniseikonia was measured with the New Aniseikonia Test. Retinal displacement (RD%) was defined as change of retinal distance between the temporal margin of the optic papilla and the intersection of the retinal vessels. Changes of thicknesses of the inner nuclear layer (INL%) and the outer retinal layer (OR%) were calculated. Aniseikonia improved postoperatively. Preoperative aniseikonia and their improvement at 6 months correlated with MH diameters (P = 0.004-0.046). Improvement of aniseikonia correlated with temporal RD% (P = 0.002-0.012). Improvement of vertical aniseikonia correlated with INL% at 2 weeks and with the nasal OR% at 1, 3, and 6 months (P = < 0.001-0.028). MH diameter and age were significant predictors for improvement of aniseikonia. The greater the temporal retina displacement, and the thinner the postoperative INL and OR, the greater the improvement of aniseikonia. MH diameter and age are strong predictors for improvement of aniseikonia after MH surgery.

Relationship between macular ganglion cell complex thickness and macular outer retinal thickness: a spectral-domain optical coherence tomography study.

BACKGROUND: To assess the relationship between macular ganglion cell complex and macular outer retinal thicknesses. DESIGN: Case-control study. PARTICIPANTS: Forty-two normal eyes and 91 eyes with primary open-angle glaucoma were studied. METHODS: Spectral-domain optical coherence tomography (RTVue-100) was used to measure the macular ganglion cell complex and macular outer retinal thickness. Ganglion cell complex to outer retinal thickness ratio was also calculated. MAIN OUTCOME MEASURES: The relationships between the ganglion cell complex and outer retinal thicknesses and between the ganglion cell complex to outer retinal thickness ratio and outer retinal thickness were evaluated. RESULTS: There was a positive correlation between ganglion cell complex and outer retinal thicknesses in the normal group and the glaucoma group (r = 0.53, P < 0.001 and r = 0.42, P < 0.001, respectively). In that respect, there was no correlation between ganglion cell complex to outer retinal thickness ratio and outer retinal thickness in the both groups (r = -0.07, P = 0.657, and r = 0.04, P = 0.677, respectively). The ganglion cell complex to outer retinal thickness ratio was 55.65% in the normal group, 45.07% in the glaucoma group. This difference was statistically significant. CONCLUSIONS: The ganglion cell complex thickness may be affected by outer retinal thickness, and there is individual variation in the outer retinal thickness. Therefore, when determining the ganglion cell complex, it seems necessary to consider the outer retinal thickness as well. We propose the ratio as a suitable parameter to account for individual variations in outer retinal thickness.

Predictors for metamorphopsia in eyes undergoing macular hole surgery.

Metamorphopsia is an important visual symptom of macular disease. We determined predictors for metamorphopsia investigating the relationships of macular hole (MH) diameter and retinal layer thicknesses with metamorphopsia after MH surgery. Forty-two eyes of 42 consecutive patients undergoing MH surgery were retrospectively studied. Metamorphopsia was measured with M-CHARTS. Inner nuclear layer (INL) and outer retinal layer (OR) thicknesses were measured 1000 µm away from central fovea at using Spectralis. Preoperative M-CHARTS scores correlated with MH diameters (P = 0.007-0.031) and changes of temporal OR thickness (P = 0.008-0.010). Postoperative M-CHARTS score at 3 months correlated with preoperative nasal and inferior OR thicknesses (P = 0.003 and 0.016) and with changes of superior INL at 3 and 6 months (P = 0.011 and 0.025), and score at 1 month with change of temporal OR at 6 months (P = 0.033). Postoperative improvement of M-CHARTS scores correlated with changes of temporal INL and superior OR (P = 0.026 and 0.002). Multiple regression analysis revealed that MH diameter was a significant predictor for metamorphopsia. Photoreceptor displacement and inner retinal change may generate metamorphopsia in MH undergoing surgery, however MH diameter is the most powerful predictor.

Outer retinal microstructure and visual function after macular hole surgery with and without Brilliant Blue G.

PURPOSE: To evaluate the outer retinal microstructure and visual function after idiopathic macular hole (MH) surgery using internal limiting membrane (ILM) peeling with and without Brilliant Blue G (BBG) staining. STUDY DESIGN: Retrospective, consecutive case series. METHODS: A total of 49 eyes of 47 patients were enrolled: 23 eyes of 23 patients with MH who underwent ILM peeling without dyes (control group) and 26 eyes of 26 patients who underwent BBG staining (BBG group). The lengths of defects of the photoreceptor ellipsoid zone (EZ), external limiting membrane (ELM), and interdigitation zone (IZ) were measured. RESULTS: The rate of MH closure after initial surgery was 95.6% (22/23 eyes) for the control group versus 100% (26/26 eyes) for the BBG group. In the 48 eyes with MH closure, the recovery rate of ELM deficiency and change in IZ deficiency showed no difference between the groups. The changes in EZ deficiency at 1 and 12 months were greater in the BBG group than in the control group. (P = 0.047 and 0.031). Visual acuity was better in the BBG group than in the control group during 12 months postoperatively (P < 0.001-0.038). CONCLUSION: Eyes undergoing BBG-assisted MH surgery achieved faster recovery of the outer retinal structures and greater visual improvement than those of eyes without BBG.

Retinal displacement and intraretinal structural changes after idiopathic macular hole surgery.

PURPOSE: To investigate the correlations of thickness of three retinal layers with retinal displacement after idiopathic macular hole surgery. STUDY DESIGN: Retrospective, consecutive, case series. METHODS: 42 eyes of 42 patients undergoing macular hole surgery with internal limiting membrane peeling were studied. Retinal distance was measured with near-infrared images between the optic nerve and the intersection of retinal vessels at four quadrants. Retinal thicknesses of inner retinal layer, inner nuclear layer and outer retinal layer were measured 1000 µm away from the central fovea using Spectralis. RESULTS: Retinal distances other than the nasal quadrant decreased postoperatively (p < 0.001). Retinal displacement (%) correlated significantly with the change in inner nuclear layer thickness in the temporal sector at 1, 3, and 6 months, in the superior sector at 2 weeks, 1, and 6 months, and in the inferior sector at 3 and 6 months postoperatively (r = 0.319-0.570, p < 0.001-0.040), but not in the inner or outer retinal layers. CONCLUSION: Internal limiting membrane peeling for macular hole enhances retinal displacement toward the optic disc, whose distances correlate with the changes in inner nuclear layer thickness.

Surgical Success Rate of Scleral Buckling Surgery and Postoperative Incidence of Cystoid Macular Edema: 10 Years of Experience at a Single Academic Hospital.

The purposes of this study were to report the surgical success rate of scleral buckling surgery (SB) for rhegmatogenous retinal detachment (RRD) in a single academic hospital, analyze the incidence of cystoid macular edema (CME) after SB using optical coherence tomography (OCT), and reveal the factors associated with the development of CME. This was a retrospective observational study of patients with RRD who underwent SB from 2010 to 2020 in a single academic hospital. The anatomical success was initially achieved in 267 of 288 eyes (92.7%), and finally achieved in 288 eyes (100%). After excluding 17 eyes that underwent vitrectomy for reoperations, a total of 271 eyes of 267 patients (173 men; age, 43.5 ± 16.9 years) were retrospectively analyzed to evaluate the incidence of postoperative CME. CME occurred in 6 of 271 eyes (2.2%) within 3 months after initial surgery. Pseudophakic and aphakic eyes appeared more likely to develop CME (chi-squared test: p = 0.0078). Five of the six cases with postoperative CME were able to be medically treated. Scleral buckling surgery showed a high success rate even in the era of small-gauge vitreous surgery, and the postoperative frequency of CME after SB was low (2.2%). Previous cataract surgery may be associated with the development of postoperative CME, which is mostly medically manageable.

Inner retinal structure and visual function after idiopathic epiretinal membrane surgery with and without brilliant blue G.

PURPOSE: Vital dyes are frequently used to visualize the internal limiting membrane (ILM) of the neuroretina. This study evaluated and compared the microstructure of the inner retina and visual function with and without brilliant blue G (BBG) staining for ILM peeling during idiopathic epiretinal membrane (ERM) surgery. STUDY DESIGN: Retrospective, consecutive, interventional case series. METHODS: Fifty-five patients (55 eyes) with ERM underwent ILM peeling without dyes (non-dye group) and 55 patients (55 eyes) underwent ILM peeling with BBG staining (BBG group). The logMAR visual acuity (VA) and ganglion cell complex (GCC) thickness were measured using optical coherence tomography at baseline and 12 months after surgery. RESULTS: LogMAR VA improved significantly in both groups at 12 months and the BBG group tended to be better than the non-dye group but with no significant difference between the groups (unpaired t-test, P = 0.490). The average GCC thickness significantly decreased in both groups; however, there was no difference in the rates of change in GCC thickness between the groups. The ratio of GCC thickness to total retinal thickness (%) was significantly higher in the BBG group in the superior quadrant at 12 months postoperatively (P = 0.010). CONCLUSION: BBG-assisted ERM surgery resulted in better visual improvement and fewer structural changes in the inner retinal layers. BBG-assisted ILM peeling is safe both functionally and anatomically.

Choroidal thickness and intraocular pressure after 25-gauge and 23-gauge vitrectomy for idiopathic epiretinal membrane.

PURPOSE: To determine the relationship between the subfoveal choroidal thickness (SCT) and intraocular pressure (IOP) following 25-gauge (25G) and 23-gauge (23G) vitrectomy for idiopathic epiretinal membrane (ERM). STUDY DESIGN: Retrospective, consecutive, interventional case series. METHODS: Sixty-two patients undergoing 25G vitrectomy and 56 patients undergoing 23G vitrectomy for ERM participated. SCT was measured using enhanced depth imaging optical coherence tomography and IOP were measured both at baseline and postoperatively. RESULTS: In both groups, the IOPs on day one and one week after surgery were significantly lower than at baseline (P < 0.001 for both). The rates of changes of IOP were significantly greater in 23G compared to 25G on day one (P = 0.026). In 23G the SCTs on day one and one week after surgery were significantly thicker (P < 0.001) than baseline. The rates of changes in SCT between baseline and day one negatively correlated with those of IOP in 23G (r = -0.559, P < 0.001) but no correlation was observed with 25G (r = -0.129, P = 0.316). CONCLUSION: Choroidal thickness increases soon after 23G vitrectomy for ERM which is probably due to the transient hypotony, however, early SCT change does not appear in 25G vitrectomy. Twenty-five-gauge vitrectomy may have an advantage in minimizing postoperative choroidal changes.

Macular vessel density in untreated normal tension glaucoma with a hemifield defect.

PURPOSE: To investigate macular vessel density (MVD) and structural alterations in untreated normal tension glaucoma (NTG) with a hemifield defect (HFD) and to compare these with the findings in healthy eyes. STUDY DESIGN: Case series with a healthy group for comparison. METHODS: Thirty-four eyes of 34 untreated NTG patients with HFD and 28 eyes of 28 healthy subjects were enrolled. RTVue-XR AvantiTM (Optovue, Inc.), a combined OCT-A and SD-OCT system, was used to determine MVD and inner macular thickness (IMT) measurements. Mean circumpapillary retinal nerve fiber (cpRNFL) and macular ganglion cell complex (mGCC) thicknesses were measured with the RTVue-100TM (Optovue, Inc.). Wilcoxon signed-rank test was used to evaluate differences between defective and normal hemifields in NTG eyes and Mann-Whitney U test to evaluate differences between normal hemifields in NTG eyes and healthy eyes. RESULTS: In comparison with healthy eyes, the normal hemifields of NTG eyes showed significantly reduced MVD, as well as cpRNFL and mGCC thicknesses, although IMT did not differ between the two groups. The defective hemifield in NTG eyes showed significantly reduced IMT, as well as cpRNFL and mGCC thicknesses, compared with the normal hemifield, although MVD did not differ between the two hemifields. CONCLUSION: Hemodynamic deficiencies and structural damage might have already begun in the perimetrically normal hemifields of NTG eyes. Further studies are needed to elucidate whether the reduction in MVD may precede structural changes or the reduction in vasculature and structural loss may vary with disease severity in at least in some cases.

Comparison of Optical Coherence Tomography Angiography and Laser Speckle Flowgraphy for the Diagnosis of Normal-Tension Glaucoma.

PURPOSE: To compare optical coherence tomography angiography (OCT-A) and laser speckle flowgraphy (LSFG) for the diagnosis of normal-tension glaucoma (NTG). METHODS: Twenty-eight eyes of 28 patients with NTG and 25 eyes of 25 normal subjects matched for age, refractive errors, systemic blood pressure, and central corneal thickness were evaluated. OCT-A was used to measure whole image vessel density, inside disc vessel density, and peripapillary vessel density; using LSFG, mean blur rate (MBR) inside the whole optic nerve head (ONH) area (MBRA), and MBR of the vessel area (MBRV) and tissue area (MBRT) inside the ONH, were determined. Receiver operating characteristic (ROC) curves and areas under the ROC (AUROC) were used to assess the diagnostic ability of each variable. RESULTS: The AUROC for OCT-A whole image vessel density (0.950) was significantly greater than that for OCT-A peripapillary vessel density (0.830) and for all LSFG parameters (MBRA = 0.793, MBRV = 0.601, and MBRT = 0.61) (P < 0.001). The AUROC for OCT-A inside disc vessel density (0.931) was significantly greater than that for all LSFG parameters (P < 0.005). CONCLUSIONS: OCT-A vessel density had a higher glaucoma diagnostic ability compared to all LSFG parameters in patients with NTG.

Association between Optic Nerve Head Microcirculation and Macular Ganglion Cell Complex Thickness in Eyes with Untreated Normal Tension Glaucoma and a Hemifield Defect.

Purpose. We evaluated the association between optic nerve head (ONH) microcirculation and macular ganglion cell complex (mGCC) thickness in patients with untreated normal tension glaucoma (NTG) and a hemifield defect. Methods. The medical records of 47 patients with untreated NTG were retrospectively reviewed. Laser speckle flowgraphy was used to obtain mean blur rate (MBR), a relative measure of blood flow. Average total deviation (TD), mGCC, and the circumpapillary retinal nerve fiber layer (cpRNFL) thickness were also analyzed. Results. All parameters corresponding to the defective hemifield were significantly lower than those corresponding to the normal hemifield. In the defective hemifield, MBR was correlated with TD, mGCC, and cpRNFL thickness. In the normal hemifield, MBR was only correlated with mGCC thickness, and multiple regression analysis showed that mGCC thickness was a significant contributing factor of the MBR. Conclusion. MBR was well correlated with mGCC thickness in eyes with untreated NTG and a hemifield defect. In the normal hemifield, mGCC thickness was a contributing factor of the MBR indicating that ONH circulatory dysfunction may be associated with retinal structural changes in the early stages of glaucoma. A reduction in ONH microcirculation may be an early indicator of the presence and progression of glaucoma.

Erratum to "Size of the Optic Nerve Head and Its Relationship with the Thickness of the Macular Ganglion Cell Complex and Peripapillary Retinal Nerve Fiber Layer in Patients with Primary Open Angle Glaucoma".

[This corrects the article DOI: 10.1155/2015/186249.].

Size of the Optic Nerve Head and Its Relationship with the Thickness of the Macular Ganglion Cell Complex and Peripapillary Retinal Nerve Fiber Layer in Patients with Primary Open Angle Glaucoma.

Purpose. To evaluate the relationships among the optic nerve head (ONH) area, macular ganglion cell complex (mGCC) thickness, circumpapillary retinal nerve fiber layer (cpRNFL) thickness, and visual field defects in patients with primary open angle glaucoma (POAG). Methods. This retrospective study included 90 eyes of 90 patients with POAG. The ONH area, rim area, mGCC thickness, and cpRNFL thickness were measured using optical coherence tomography. Mean deviation (MD) was measured using standard automated perimetry. The relationships among clinical factors including age, refraction, the ONH area, the rim area, the mGCC thickness, the cpRNFL thickness, and MD were evaluated using correlation coefficients and multiple regression analyses. Results. The significant correlation of the ONH area with refraction (r = 0.362, P < 0.001), the mGCC thickness (r = 0.225, P = 0.033), and the cpRNFL thickness (r = 0.253, P = 0.016) was found. Multiple regression analysis showed that the ONH area, rim area, and MD were selected as significant contributing factors to explain the mGCC thickness and cpRNFL thickness. No factor was selected to explain MD. Conclusions. The ONH area, in other words, the disc size itself may affect the mGCC thickness and cpRNFL thickness in POAG patients.

Influence of axial length on ganglion cell complex (GCC) thickness and on GCC thickness to retinal thickness ratios in young adults.

PURPOSE: The present study was designed to investigate the influence of axial length on macular ganglion cell complex (GCC) thickness and two ratio parameters-the GCC thickness to macular total retinal thickness (G/T) ratio and the GCC thickness to macular outer retinal thickness (G/O) ratio-using spectral-domain optical coherence tomography (OCT). METHODS: In this prospective case series, 74 eyes of 74 healthy Japanese study participants with varying degrees of myopia were recruited. GCC, outer retinal, and total retinal thicknesses were measured with the RTVue-100 system. The G/T and G/O ratios were also calculated. The axial length was determined using the IOLMaster. The correlation between the OCT measurements and axial length was evaluated. RESULTS: The average axial length was 25.05 ± 1.38 mm. The GCC thickness was significantly correlated with axial length (r = -0.384, P = 0.001). The outer retinal thickness and the total retinal thickness were significantly correlated with axial length (r = -0.444, P < 0.001 and r = -0.493, P < 0.001, respectively), but the G/T and G/O ratios were not (r = -0.093, P = 0.428 and r = -0.091, P = 0.440, respectively). CONCLUSIONS: GCC thickness is affected by axial length. Because the prevalence of myopia is high in Japan, when determining the GCC thickness of Japanese individuals, it seems necessary to consider the axial length as well. To take account of individual variation in axial length, we propose the ratio parameters as a suitable parameter.

Ability of optical coherence tomography-determined ganglion cell complex thickness to total retinal thickness ratio to diagnose glaucoma.

PURPOSE: To evaluate the usefulness of the spectral-domain optical coherence tomography (SD OCT)-determined ganglion cell complex thickness to total retinal thickness ratio (G/T ratio) in diagnosing glaucoma. METHODS: A total of 99 eyes with primary open-angle glaucoma and 35 normal eyes were enrolled in the study. SD OCT (RTVue-100) was used to measure the macular ganglion cell complex thickness, total retinal thickness, outer retinal thickness, and circumpapillary retinal nerve fiber layer (RNFL) thickness. A new macular parameter, the G/T ratio, was also calculated. The ability of each parameter to diagnose glaucoma was examined by analyzing the area under the receiver operating characteristics curve (AUROC) and the sensitivity at fixed specificity. RESULTS: The G/T ratio was 36.0 ± 1.5% in normal eyes, 31.8 ± 1.7% in early glaucoma, and 30.2 ± 2.6% in advanced glaucoma. These decreases in the ratio were statistically significant. For the AUROC, the individual SD OCT parameters were 0.982 for the G/T ratio, 0.968 for the macular ganglion cell complex thickness, 0.942 for the RNFL thickness, and 0.841 for the total retinal thickness. The AUROC for the G/T ratio was significantly higher than that seen for the total retinal and RNFL thicknesses (P<0.05). Analyses of the sensitivity at a specificity of >90% indicated that the G/T ratio (sensitivity, 93.94%) was the best diagnostic parameter. CONCLUSIONS: Decreases in the G/T ratio occur during the early stages of glaucoma. When using SD OCT to diagnose glaucoma, the G/T ratio may improve the diagnostic ability of the macular parameter.