Search Results (69)

Background: Evidence guiding secondary repair of persistent full-thickness macular holes (FTMHs) remains limited and heterogeneous. Temporal arcuate relaxing retinotomy has been described as a salvage maneuver intended to increase temporal retinal compliance, yet functional safety data are scarce. We report consecutive real-world outcomes of temporal arcuate relaxing retinotomy for persistent FTMHs after failed standard repair(s). Methods: Retrospective consecutive case series of patients with persistent FTMH after ≥1 pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, treated with repeat PPV and temporal arcuate relaxing retinotomy. Outcomes included OCT (Optical Coherence Tomography)-confirmed closure after gas absorption and best-corrected visual acuity (BCVA, logMAR), ellipsoid zone (EZ) status, retinotomy-site morphology on OCT/fundus autofluorescence (FAF), and safety/functional outcomes (systematic scotoma symptom inquiry; Humphrey visual field testing when feasible). Exact binomial 95% confidence intervals (CI) were calculated for proportions. Results: Nine eyes (median age 70 years; range 55–76) underwent temporal arcuate relaxing retinotomy for persistent FTMH. Minimum linear diameter ranged 412–1037 µm (median 613 µm). OCT-confirmed closure was achieved in 7/9 eyes (77.8%; 95% CI 40.0–97.2) at a mean follow-up of 5.9 months (range 2–12). BCVA improved in 8/9 eyes (88.9%; 95% CI 51.8–99.7); mean BCVA improved from 1.26 ± 0.51 logMAR pre-operatively to 0.61 ± 0.18 logMAR at last follow-up (mean change −0.64 logMAR; Wilcoxon signed-rank test p = 0.011). As a sensitivity analysis, the paired t-test yielded p = 0.008. Humphrey visual fields were obtained in 6/9 eyes; one patient reported a new paracentral nasal scotoma, which was subjectively well tolerated. Conclusions: In this small consecutive series, temporal arcuate relaxing retinotomy was associated with a 78% closure rate and mean BCVA improvement in eyes with persistent FTMH after failed standard repair(s), with limited symptomatic scotoma reporting in those assessed. Given the retrospective design, small cohort, and incomplete standardized functional testing, larger comparative studies with uniform functional endpoints (microperimetry, RNFL/GCL metrics, and systematic perimetry) are needed to define patient selection, reproducibility, and relative performance versus contemporary salvage options. Full article

Background/Objectives: The aim of the present study was to identify preoperative functional and anatomical parameters that better predict postoperative best corrected visual acuity (BCVA) after full-thickness macular hole (MH) surgery during long-term follow-up. Methodology: Initial visual outcomes, medical history, retinal imaging data, microperimetry and mfERG measurements were collected to characterise functional and morphological macular status. Results: Among the study subjects, 22 presented with a BCVA > 0.5, and 20 presented with a BCVA ≤ 0.5 at the final visit. Multivariate regression analysis revealed that a smaller minimum MH diameter (OR = 0.98; 95% CI = 0.87–0.99; p = 0.004) and a shorter disease duration (OR =0.11; 95% CI = 0.02–0.53; p = 0.005) were predictors of postoperative long-term BCVA > 0.5. Baseline P wave amplitudes in the central ring on mfERG were positively correlated with postoperative BCVA gain (Rs = +0.53, p = 0.001). Conclusions: Our findings corroborate the significance of hole diameter measurements for postoperative visual outcomes and support the rationale of early intervention. Full article

Age-related macular degeneration (AMD) significantly impacts central vision, fixation site and stability and reading abilities. This work aims to analyze the relationship between retinal fixation parameters measured using microperimetry and reading performance in patients with AMD. We identified the role of fixation stability measurement in the evaluation of reading abilities and discussed its implications both in clinical practice and in clinical trials. Our analysis highlights the importance of retinal fixation assessment as a precise surrogate for evaluating reading ability outcomes in AMD patients and as new clinical endpoint to demonstrate the functional effects of present and emerging target therapies. Full article

Background: Rhegmatogenous retinal detachment (RRD), the most common type of retinal detachment, requires prompt surgery to reattach the retina and avoid permanent vision loss. While surgical treatment is adapted to each individual case, one frequent option is pars plana vitrectomy (PPV) with silicone oil (SO) tamponade. Despite achieving anatomical success (complete retinal attachment), concerns persist regarding potential microvascular alterations in the retina and choroid, with a negative impact on visual function. Optical coherence tomography angiography (OCTA) allows detailed, in-depth imaging of retinal and choroidal circulation, whereas microperimetry makes it possible to accurately assess macular function. This review aims to strengthen the existing evidence on vascular and functional alterations at the macular level after SO tamponade in cases of RRD. Methods: A narrative review was conducted using a structured approach, utilizing a PubMed search from January 2000 up to April 2025. Twenty-three studies on OCTA and microperimetry after SO tamponade for RRD were included. Data on vessel densities, choroidal vascular index (CVI), foveal avascular zone (FAZ) size, and retinal sensitivity were extracted and qualitatively analyzed. Results: Studies consistently reported a reduction in the vessel density within the superficial capillary plexus (SCP) under SO tamponade, with partial but incomplete reperfusion post-removal. Choroidal perfusion and CVI were also decreased, exhibiting a negative correlation with the duration of SO tamponade. Microperimetry demonstrated significant reductions in retinal sensitivity (~5–10 dB) during SO tamponade, which modestly improved (~1–2 dB) following removal but generally remaining below normal levels. Conclusions: SO tamponade causes substantial retinal and choroidal vascular impairment and measurable macular dysfunction, even after anatomical reattachment of the retina. It is recommended to perform early SO removal (~3–4 months) and implement routine monitoring by OCTA and microperimetry with the aim of optimizing patient outcomes. Future research should focus on investigating protective strategies and enhancing visual rehabilitation following RRD repair. Full article

Background: This prospective pilot study included four participants with chronic visual impairment and assessed functional and electrophysiological recovery following visual evoked potential (VEP)-guided auditory biofeedback across diverse etiologies. Low vision affects more than two billion people worldwide and imposes a sustained personal and socioeconomic burden. Conventional rehabilitation emphasizes optical aids and environmental modification without directly stimulating the visual pathway. Emerging evidence indicates that auditory biofeedback based on real-time cortical activity can leverage adult neuroplasticity. Methods: Four men (mean age 58 ± 12 years) with chronic visual impairment attributable to occipital stroke, stage IV macular hole, end-stage open-angle glaucoma, or diabetic maculopathy completed ten 10-min monocular sessions with the Retimax Vision Trainer over three weeks (15 Hz pattern reversal, 90% contrast). Primary end points were best corrected visual acuity (BCVA, ETDRS letters) and P100 amplitude/latency. Fixation stability was recorded with MAIA microperimetry when feasible. A focused PubMed review (2010–2025) mapped current evidence and research gaps. Results: Median BCVA improved by seven letters (IQR 0–15); three of eight eyes gained ≥ 10 letters and none lost vision. Mean P100 amplitude increased from 1.0 ± 1.2 µV to 3.0 ± 1.1 µV, while latency shortened by 3.9 ms. Electrophysiological improvement paralleled behavioural gain irrespective of lesion site. No adverse events occurred. Conclusions: A concise course of VEP-guided auditory biofeedback produced concordant functional and neurophysiological gains across retinal, optic nerve, and cortical pathologies. These pilot data support integration of closed-loop biofeedback into routine low vision care and justify larger sham-controlled trials. Full article

This study investigates reading performances and eye movements in individuals with eccentric fixation due to age-related macular degeneration (AMD). Overall, 17 individuals with bilateral AMD (7 males; mean age 77.47 ± 5.96 years) and 17 controls (10 males; mean age 72.18 ± 5.98 years) were assessed for reading visual acuity (VA), reading speed (Minnesota low vision reading chart in Slovene, MNREAD-SI), and near contrast sensitivity (Pelli-Robson). Microperimetry (NIDEK MP-3) was used to evaluate preferential retinal locus (PRL) location and fixation stability. Eye movements were recorded with Tobii Pro-glasses 2 and analyzed for reading duration, saccade amplitude, peak velocity, number of saccades, saccade duration, and fixation duration. Individuals with AMD exhibited significantly reduced reading indices (worse reading VA (p < 0.001), slower reading (p < 0.001), and lower near contrast sensitivity (p < 0.001)). Eye movement analysis revealed prolonged reading duration, longer fixation duration, and an increased number of saccades in individuals with AMD per paragraph. The number of saccades per paragraph was significantly correlated with all measured reading indices. These findings provide insights into reading adaptations in AMD. Simultaneously, the proposed approach in analyzing eye movements puts forward eye trackers as a prospective diagnostic tool in ophthalmology. Full article

Background/Objectives: Epiretinal membrane (ERM) is often associated with macular thickening and foveal intraretinal fluid. The aim of this study was to evaluate the efficacy of early postoperative SMLT (577 nm) in preventing persistent macular oedema and to assess its impact on selected functional and morphometric retinal parameters after ERM peeling. Methods: A total of 68 pseudophakic patients with ERMs were enrolled and randomly assigned (1:1) to a laser group or a nonlaser control group. SMLT was performed one month after PPV. The functional and morphometric retinal parameters were assessed preoperatively and at one and four months postoperatively via optical coherence tomography (OCT), OCT angiography (OCTA), multifocal electroretinography (mfERG), and microperimetry. Results: The reduction in total retinal volume between the first and fourth postoperative months was significantly greater in the SMLT group than in the control group (p = 0.02). No significant differences in functional parameters were found between the groups. A more substantial reduction in total retinal volume post-SMLT was associated with greater baseline macular thickness, a more advanced ERM stage, worse baseline visual acuity, greater fixation stability, lower initial macular sensitivity and lower preoperative p-wave amplitude in ring R1 on mfERG. Conclusions: SMLT may be considered a therapeutic option in patients with advanced ERM stages and low preoperative visual acuity. Full article

Visual field (VF) testing remains a cornerstone in assessing retinal function by measuring how well different parts of the retina detect light. It is essential for early detection, monitoring, and management of many retinal diseases. By mapping retinal sensitivity, VF exams can reveal functional loss before structural changes become visible. This review summarizes how VF testing is applied across key conditions: hydroxychloroquine (HCQ) retinopathy, age-related macular degeneration (AMD), diabetic retinopathy (DR) and macular edema (DME), and inherited disorders including inherited dystrophies such as retinitis pigmentosa (RP). Traditional methods like the Goldmann kinetic perimetry and simple tools such as the Amsler grid help identify large or central VF defects. Automated perimetry (e.g., Humphrey Field Analyzer) provides detailed, quantitative data critical for detecting subtle paracentral scotomas in HCQ retinopathy and central vision loss in AMD. Frequency-doubling technology (FDT) reveals early neural deficits in DR before blood vessel changes appear. Microperimetry offers precise, localized sensitivity maps for macular diseases. Despite its value, VF testing faces challenges including patient fatigue, variability in responses, and interpretation of unreliable results. Recent advances in artificial intelligence, virtual reality perimetry, and home-based perimetry systems are improving test accuracy, accessibility, and patient engagement. Integrating VF exams with these emerging technologies promises more personalized care, earlier intervention, and better long-term outcomes for patients with retinal disease. Full article

Objectives: Insulin plays a crucial role in neuronal survival and oxidative stress modulation, making it a potential therapeutic target. This study investigates the effects of insulin in combination with a mesenchymal cell-derived secretome in patients with degenerative neuroretinal diseases. Methods: Sixty-four patients with severe neuroretinal diseases who had previously undergone the Limoli Retinal Restoration Technique (LRRT) were included in this longitudinal study and divided into groups: group 1 received a single injection of 5 units of insulin lispro into the suprachoroidal space of the worse-seeing eye; group 2 received insulin injection in the better-seeing eye. Retinal function was assessed using microperimetry (MY) before and after treatment (approximately 1 year for eye drops). Group 3 consisted of patients who demonstrated improvement in MY after insulin injection. These patients continued treatment with daily insulin eye drops. Results: In group 1, insulin-treated eyes showed a significant increase in retinal sensitivity from 10.09 dB to 10.75 dB (p = 0.0067), while untreated eyes declined from 12.35 dB to 11.92 dB (p = 0.0448). In group 2, insulin-treated eyes improved from 10.8 dB to 11.63 dB (p = 0.05), whereas untreated eyes exhibited a decline from 8.68 dB to 8.50 dB (p = 0.6771). In group 3, patients using insulin eye drops showed a stabilization or mild increase in retinal sensitivity, from 11.39 dB to 11.73 dB (p = 0.231). Conclusions: The addition of insulin in patients previously treated with the LRRT was associated with improved sensitivity and a stabilizing effect on neuroretinal function. Full article

Purpose: We sought to evaluate the long-term effects of oral citicoline; vitamins A, B, C, and E; and blackcurrant therapy in patients with primary open-angle glaucoma (POAG) using optical coherence tomography (OCT), OCT angiography (OCTA), and microperimetry parameters. Materials and Methods: Fifteen patients with POAG (the treated group) received one soluble liquid sachet of a complementary dietary supplement containing, in a fixed combination, citicoline; vitamins A, B, C, and E; and blackcurrant (Citizin^®, Bruschettini s.r.l., Genova, Italy) daily for 20 days a month for 1 year. Fifteen age-matched patients with POAG were given a placebo and served as a control group. The patients underwent best-corrected visual acuity (BCVA) analysis, Goldmann applanation tonometry, microperimetry examination, OCT, and OCTA at the beginning of the study and then 1, 6, and 12 months later. Results: A significant improvement in the overall retinal nerve fiber layer (RNFL) thickness values (compared with the control group) was recorded at the 6- (p < 0.009) and 12 (p < 0.001)-month follow-ups in the treated group. The ganglion cell complex (GCC) increased in thickness (compared with the control group) at the 12-month follow-up (p < 0.0001) in the treated group. The mean macular vessel density (MVD) and the mean peripapillary vessel density (PVD) in the treated group were significantly higher than those in the control group at the 12-month follow-up. Microperimetry examination, BCVA, and Goldmann applanation tonometry showed no statistically significant alterations. Conclusions: A fixed combination of citicoline; vitamins A, B, C, and E; and blackcurrant administered orally may have a positive impact on RNFL, GCC, MVD, and PVD in patients with POAG. Full article

Objectives: In this study, the objective was to assess the correlation between macular function and peripapillary retinal nerve fiber layer (pRNFL) thickness following successful rhegmatogenous retinal detachment (RRD) surgery, as well as the subsequent recovery of visual acuity. Methods: This was a cross-sectional study including 64 eyes from patients with RRD who underwent successful treatment with 23G pars plana vitrectomy (PPV), endophotocoagulation and sulfur-hexafluoride (SF6) were included and compared to a control group consisting of 136 healthy eyes. A complete ophthalmological examination was performed on all participants, including assessment of macular sensitivity using macular integrity assessment (MAIA) microperimetry and pRNFL thickness using DRI-Triton swept-source (SS)–optical coherence tomography (OCT). Results: In the RRD group, retinal sensitivity was decreased. The temporal (T) sector of the total retina (TR) protocol was thicker, while the superior (S) and inferior (I) sectors of the pRNFL protocol were thinner. Within the RRD group, positive correlations were observed between the nasal (N), I sectors and total thickness of TR protocol and MAIA inferior outer (IO) sector; the I sector and total thickness of the TR protocol and MAIA inferior inner (II) sector; the I sector of the pRNFL protocol and MAIA IO sector. Negative correlations were shown between the S, T sectors and total thickness of the pRNFL protocol and MAIA central (C) sector; the N sector and total thickness of the pRNFL protocol and MAIA central temporal (CT) sector. Conclusions: RRD leads to a decrease in pRNFL thickness accompanied by reduced macular sensitivity. These changes may be attributed to factors such as the specific location of the RRD, the distribution pattern of the RNFL and the chosen surgical approach. Full article

Background: Best-corrected visual acuity (BCVA) is the current gold standard of retinal function measurement but is not affected in early and intermediate forms of age-related macular degeneration (AMD). Increasing evidence suggests that microperimetry is a sensitive measure of visual function. This study sought to analyze the associations between plasma and urine metabolites and microperimetry in AMD. Methods: We included data on 363 eyes (95 controls, 268 AMD). Microperimetry was performed in patients with or without AMD using the Macular Integrity Assessment (MAIA) microperimetry system, employing a 37-point full-threshold protocol. Plasma and urine samples were analyzed via ultra-high-performance liquid chromatography–mass spectrometry. Multilevel mixed-effects linear models were used to assess associations between the metabolites and retinal sensitivity. Statistical significance was determined by considering the number of independent tests that accounted for 80% of the variance (ENT80). Results: We identified two plasma and seven urine metabolites, which were significantly associated with mean retinal sensitivity in AMD, and the key results include metabolites in the lysine metabolism pathway. Conclusions: To our knowledge, we present the first assessment of the associations between plasma and urinary metabolites and retinal microperimetry sensitivity in AMD. This work can reveal more insight into the pathogenesis of AMD. Full article

Eyes with maculopathy usually have poor fixation stability (FS) and develop a new preferred retinal locus (PRL). The exact FS and PRL have never been studied in diabetic macular ischemia (DMI). In this one-year observational study, we recruited 79 patients (145 eyes) with evidence of DMI on optical coherence tomography angiography (OCTA). Microperimetry (MP) was performed at baseline and 52 weeks. Overall, DMI eyes demonstrated relatively stable FS without evolving into eccentric fixation over one year. When comparing the better-seeing eye (BSE) with the worse-seeing eye (WSE) in eyes with bilateral DMI, the latter presented with a larger bivariate contour ellipse area (BCEA) initially but gradually aligned with the one in the BSE at the end of the study. Conversely, the foveolar retinal sensitivity (RS) worsened significantly alongside the extension of disorganization of the retinal inner layers (DRIL) in the WSE at one year despite the best-corrected visual acuity (BCVA) being maintained. This suggests that foveolar RS might reflect the start of DMI deterioration more sensitively than BCVA. Full article

Background: A cross-sectional study was conducted at Moorfields Eye Hospital, UK, involving patients with CRB1-associated retinopathies: macular dystrophy (MD), cone-rod dystrophy (CORD), and early-onset severe retinal dystrophy/Leber congenital amaurosis (EOSRD/LCA). The study aimed to evaluate CRB1-associated retinopathies using microperimetry (macular integrity assessment (S-MAIA) fast protocol) and spectral domain optical coherence tomography (SD-OCT). Methods: Data quality and participant attrition were assessed in 18 patients (10 MD, 5 EOSRD/LCA, 3 CORD), aged 10–52 years, with a median best corrected visual acuity (BCVA) of 0.41 logMAR. Results: Microperimetry and SD-OCT data were obtained from 14 and 18 patients, respectively, but eccentric fixation hindered structure-function analysis. All participants showed overall abnormal sensitivity on the S-MAIA fast protocol. Parafoveal volume was significantly increased, while foveal thickness and volume were reduced compared to normative data (p < 0.01). Conclusions: This study highlights the challenges of participant attrition and the need for alternative functional metrics to complement traditional evaluations. It also reinforces previous findings of abnormal retinal architecture in CRB1-associated retinopathies, providing further insights into S-MAIA and SD-OCT assessments for this patient population. Full article

Objectives: We sought to investigate the visual function, retinal features, and genotype–phenotype correlations of an Australian cohort of RPGR carriers. Methods: In this cross-sectional study, we evaluated RPGR carriers seen in Melbourne and Perth between 2013 and 2023 and healthy women seen between 2022 and 2023 in Melbourne. Visual acuity tests, fundus-tracked microperimetry, and retinal imaging were performed. RPGR carriers were classified into four retinal phenotypes (normal, radial, focal pigmentary retinopathy, and male pattern phenotype) and compared against healthy controls. Genotype–phenotype relationships in the RPGR carriers were investigated. Results: Thirty-five female RPGR carriers and thirty healthy controls were included in this study. The median ages were 40 and 48.5 years for RPGR carriers and controls, respectively (p = 0.26). Most RPGR carriers (89%) had a genetic diagnosis. Best-corrected visual acuity (BCVA), low luminance visual acuity, retinal sensitivity, central inner retinal thickness (IRT, 1°), and photoreceptor complex (PRC) thickness across the central 1–7° of the retina differed between phenotypes of RPGR carriers. On average, RPGR carriers with ORF15 variants (n = 25 carriers) had reduced LLVA, a greater IRT at 1°, and thinner PRC thickness at 7° from the fovea (all p < 0.05) compared to those with exon 1–14 variants. Conclusions: Female RPGR carriers with severe retinal phenotypes had significantly decreased visual function and changes in retinal structure in comparison to both the controls and carriers with mild retinal disease. BCVA, LLVA, retinal sensitivity, and retinal thickness are biomarkers for detecting retinal disease in RPGR carriers. The genetic variant alone did not influence retinal phenotype; however, RPGR carriers with ORF15 variants exhibited reduced retinal and visual measurements compared to those with exon 1–14 variants. Full article