Central retinal sensitivity measured with the micro perimeter 1 after photodynamic therapy for polypoidal choroidal vasculopathy

Regenerative Retinal Laser and Light Therapies (RELITE): Proposal of a New Nomenclature, Categorization, and Trial Reporting Standard

OBJECTIVES

Numerous laser and light therapies have been developed to induce regenerative processes in the choroid/retinal pigment epithelium (RPE)/photoreceptor complex, leaving the neuroretina undamaged. These therapies are applied to the macula for the treatment of various diseases, most prominently diabetic maculopathy, retinal vein occlusion, central serous chorioretinopathy, and age-related macular degeneration. However, the abundance of technologies, treatment patterns, and dosimetry protocols has made understanding these therapies and comparing different approaches increasingly complex and challenging. To address this, we propose a new nomenclature system with a clear categorization that will allow for better understanding and comparability between different laser and light modalities. We propose this nomenclature system as an open standard that may be adapted in future toward new technical developments or medical advancements.

METHODS

A systematic literature review of reported macular laser and light therapies was conducted. A categorization into a standardized system was proposed and discussed among experts and professionals in the field. This paper does not aim to assess, compare, or evaluate the efficacy of different laser or dosimetry techniques or treatment patterns.

RESULTS

The literature search yielded 194 papers describing laser techniques, 50 studies describing dosimetry, 272 studies with relevant clinical trials, and 82 reviews. Following the common therapeutic aim, we propose "regenerative retinal laser and light therapies (RELITE)" as the general header. We subdivided RELITE into four main categories that refer to the intended physical and biochemical effects of temperature increase (photothermal therapy, PTT), RPE regeneration (photomicrodisruption therapy, PMT), photochemical processes (photochemical therapy, PCT), and photobiomodulation (photobiomodulation therapy, PBT). Further, we categorized the different dosimetry approaches and treatment regimens. We propose the following nomenclature system that integrates the most important parameters to enable understanding and comparability: Pattern-Dosimetry-Exposure Time/Frequency, Duty Cycle/Irradiation Diameter/Wavelength-Subcategory-Category.

CONCLUSION

Regenerative retinal laser and light therapies are widely used for different diseases and may become valuable in the future. A precise nomenclature system and strict reporting standards are needed to allow for a better understanding, reproduceable and comparable clinical trials, and overall acceptance. We defined categories for a systematic therapeutic goal-based nomenclature to facilitate future research in this field.

Evaluation and comparison of microperimetry and optical coherence tomography findings in patients with Behçet uveitis

PURPOSE

To evaluate and compare the findings of MP and OCT in patients with inactive Behçet's uveitis (BU).

METHODS

Sixty-five eyes of 38 patients were included in this retrospective study. Ophthalmologic examination findings and OCT and MP results were recorded. The relationship between best corrected visual acuity (BCVA), duration of uveitis, central macular thickness (CMT), presence of photoreceptor zone (PZ), and/or retinal pigment epithelium (RPE) damage, macular integrity index, mean threshold and fixation stability was analyzed.

RESULTS

There was a positive correlation between BCVA and CMT (p < 0.001). The eyes with PZ and/or RPE damage had significantly lower visual acuity (p < 0.001). There was a negative correlation between BCVA and macular integrity index (p = 0.005). BCVA showed positive correlations with mean threshold and fixation stability [(BCVA vs. mean threshold, p < 0.001), (BCVA vs. P1, p < 0.001), and (BCVA vs. P2, p < 0.001)]. While there was no significant correlation between CMT and macular integrity index (p = 0.08), both mean threshold and fixation stability were significantly positively correlated with CMT [(CMT vs. mean threshold, p = 0.01), (CMT vs. P1, p = 0.008), and (CMT vs. P2, p = 0.005)]. Mean threshold and fixation stability (P1 and P2) were significantly lower in the eyes with PZ and/or RPE damage (p = 0.008, p = 0.02, and p = 0.01, respectively).

CONCLUSION

MP showed results consistent with visual acuity and morphological findings by OCT in patients with inactive BU. Although MP is promising for patient follow-up, controlled prospective studies are needed.

Microperimetry and multimodal imaging in polypoidal choroidal vasculopathy

Polypoidal choroidal vasculopathy (PCV) is a degenerative macular disease. The study determined the topographical concordance in the areal extent of PCV, defined by indocyanine green angiography (ICGA), and the corresponding outcomes from spectral-domain optical coherence tomography (SD-OCT) and microperimetry, in 25 individuals (25 eyes) who had undergone 3 months of anti-vascular endothelial growth factor treatment. The differential light sensitivity within 10° eccentricity was evaluated by Pattern Deviation probability analysis. The concordances and proportional areal extents of the abnormality for ICGA, SD-OCT and microperimetry were compared. The concordance in the areal extent between all three modalities was 59%. The median concordance between ICGA and microperimetry was 60%; between ICGA and SD-OCT, 70%; and between SD-OCT and microperimetry, 72%. SD-OCT and microperimetry each identified a greater areal extent (>20%) compared to ICGA in 13 and 19 eyes, respectively. A greater areal extent (>20%) was present in 9 eyes for microperimetry compared to SD-OCT and in 5 eyes for SD-OCT compared to microperimetry. SD-OCT and microperimetry each identified a greater area of abnormality than ICGA which supports the clinical utility of SD-OCT. Strong concordance was present between SD-OCT and microperimetry; however, microperimetry identified additional areas of functional abnormality.

Polypoidal choroidal vasculopathy: Pearls in diagnosis and management

Polypoidal choroidal vasculopathy (PCV) is increasingly recognized as an important cause of exudative maculopathy in Asians as against Wet age-related macular degeneration in Caucasians. A panel of retinal experts methodically evaluated pertinent updated literature on PCV with thorough PubMed/MEDLINE search. Based on this, the panel agreed upon and proposed the current consensus recommendations in the diagnosis (clinical and imaging), management and follow-up schedule of PCV. Diagnosis of PCV should be based on the gold standard indocyanine green angiography which demonstrates early nodular hyperfluorescence signifying the polyp with additional features such as abnormal vascular network (AVN). Optical coherence tomography is an excellent adjuvant for diagnosing PCV, monitoring disease activity, and decision-making regarding the treatment. Current treatment modalities for PCV include photodynamic therapy, anti-vascular endothelial growth factor agents, and thermal laser. Choice of specific treatment modality and prognosis depends on multiple factors such as the location and size of PCV lesion, presence or absence of polyp with residual AVN, amount of submacular hemorrhage, presence or absence of leakage on fundus fluorescein angiography, visual acuity, and so on. Current recommendations would be invaluable for the treating physician in diagnosing PCV and in formulating the best possible individualized treatment strategy for optimal outcomes in PCV management.

Different fixation targets affect retinal sensitivity obtained by microperimetry in normal individuals

Purpose

To determine the differences in the retinal sensitivities obtained by microperimetry with a single cross or a circular fixation target in normal individuals.

Methods

Thirty-two eyes of 16 healthy volunteers (mean age 28.9±1.4 years, range 24-44 years) were studied. The retinal sensitivity of the central 0 degrees and of the mean central 2 degrees consisting of 8 points were determined independently using the two different fixation targets with Microperimeter 3. The Goldmann III stimulus with a luminance of 1.0 cd/m² was presented for 200 ms on a white background.

Results

The retinal sensitivity of the central 0 degrees was significantly better with the circular target than that with the cross target (P=0.003, right eyes; P=0.001, left eyes). The mean retinal sensitivity in the central 2 degrees was not significantly different between the cross and circular fixation targets. (P=0.07, right eyes; P=0.08, left eyes).

Conclusion

These results indicate that the circular fixation target is a better target to use to evaluate the central retinal sensitivity. The difference in the retinal sensitivity is most likely due to the cross fixation target overlapping the test stimulus target.

Microperimetric assessment of retinal sensitivity in eyes with diabetic macular edema from a phase 2 study of intravitreal aflibercept

PURPOSE

To evaluate retinal sensitivity in patients with diabetic macular edema who received intravitreal aflibercept injection (IAI) or laser.

METHODS

A substudy included 46 patients from DA VINCI (a randomized, double-masked Phase 2 study) receiving either laser, 0.5 mg IAI every 4 weeks, 2 mg IAI every 4 weeks, 2 mg IAI every 8 weeks after 3 monthly doses (2q8), or 2 mg IAI as-needed after 3 monthly doses for 52 weeks. Retinal sensitivity was measured in one (central), five (one central and four inner), and eight (four inner and four outer) optical coherence tomography subfields.

RESULTS

Mean best-corrected visual acuity improvement in the subgroup at Week 52 was 3.3 letters with laser and ranged from 5.4 to 16.3 letters in the IAI groups. Retinal sensitivity of laser patients at Week 52 was comparable with baseline in the central optical coherence tomography subfield but decreased in the five and eight optical coherence tomography subfields. Compared with laser, retinal sensitivity significantly increased with IAI in the 2q8 and pooled IAI groups in the 5 and 8 optical coherence tomography subfields at Week 52 (P < 0.05).

CONCLUSION

Intravitreal aflibercept injection improved best-corrected visual acuity and retinal sensitivity in this subgroup of patients. Laser may cause a deterioration of macular function that is not detectable with best-corrected visual acuity testing.

Correlation between fundus autofluorescence and central visual function in chronic central serous chorioretinopathy

PURPOSE

To find possible correlations between the morphologic macular changes revealed by fundus autofluorescence (FAF) and the functional parameters such as visual acuity and retinal sensitivity in patients with chronic central serous chorioretinopathy (CSC).

DESIGN

Prospective, cross-sectional study.

METHODS

Forty-six eyes (39 consecutive patients) with chronic CSC were studied with FAF and microperimetry (MP). Retinal sensitivity value maps were exactly superimposed over FAF images. The following microperimetric parameters were applied: central 10-degree visual field, 4-2-1 strategy, 61 stimulation spots, white monochromatic background, stimulation time 200 ms, stimulation spot size Goldmann III. A possible relationship between MP and FAF was investigated.

RESULTS

Mean best-corrected visual acuity (BCVA) was 20/32 (median 20/25, range 20/20-20/200). BCVA was significantly correlated with FAF findings (Mann-Whitney test; P < .0001). A positive concordance between FAF and MP evaluation was also found (total concordance of 0.720 with a kappa of Cohen of 0.456). The hypo-autofluorescent areas showed decreased retinal sensitivity, while adjacent areas of increased FAF could be associated to both normal and decreased retinal sensitivity. Absolute scotoma, defined as 0 dB retinal sensitivity, corresponded with absence of autofluorescence.

CONCLUSIONS

Altered FAF in chronic CSC patients has a functional correlation quantified by microperimetry. This study confirms the impact of FAF changes on retinal sensitivity and their value to reflect the functional impairment in chronic CSC.

Microperimetry and clinical practice: an evidence-based review

Microperimeters embody technological abilities required to assess components of residual visual functions and functional vision. Residual visual functions and functional vision after macular vision loss are mostly defined by 3 major components: scotoma characteristics, preferred retinal loci (PRLs) and oculomotor control. Microperimetry may be proven superior as a method to standard automated perimetry (SAP) for residual visual function assessment. During microperimetry stimuli are projected directly on the retina with accurate test-retest of the same retinal point monitored by eye tracking technology. Microperimeters offer also abilities to determine accurately the location of a PRL. Recent research reveals also that fixation stability estimates in low vision cases are reliable predictors of visual acuity estimates. Fixation stability estimates provided automatically by the microperimeters are based on proprietary algorithms and provide reasonable estimates very close to BCEA values calculated from raw data. More and more microperimeters are used in clinical retina practice to assess more accurately the impact of diseases or of interventions on the retina. Microperimeters are also in use more often in glaucoma practices and it seems evident that the main usage for microperimeters is destined to monitor glaucoma damaged residual visual functions and functional vision. In addition identification of eccentric location of PRLs and fixation stability estimates at the PRL in low vision patients offers the LVR practitioner the option to use the best residual visual function available for rehabilitation. For mainstream ophthalmology many indicators point to the fact that microperimeters may take the lead role played by SAP in the last decades. For vision rehabilitation practitioners the advent of multiple choices for microperimetry portends the introduction of modern rehabilitation concepts in most clinical practices. Both developments seem to happen sooner, rather than later as expected by most.

Application of multifocal visual evoked potentials in the assessment of visual dysfunction in macular diseases

PURPOSE

To evaluate the use of AccuMap multifocal visual evoked potentials (mfVEP) in visual dysfunction caused by macular diseases.

METHODS

Forty-eight eyes with known macular diseases underwent AccuMap mfVEP and microperimetry 1 (MP1) assessments. Evaluation of mfVEP abnormality was based on an amplitude deviation probability plot and the AccuMap Severity Index (ASI). Correlation analyses of the mean mfVEP amplitude corresponding to a radius of 2°, 5°, and 10° of the central visual field, minimum angle of resolution best-corrected visual acuity (BCVA), and MP1 mean sensitivity of the corresponding areas were performed.

RESULTS

Among the 48 affected eyes, AccuMap mfVEP detected an abnormality of the central visual field in 45 eyes, with a sensitivity of 93.8%. The mean mfVEP amplitudes within a radius of 2°, 5°, and 10° of the central visual field were found to be positively correlated with BCVA (P<0.01 for all groups). The mean amplitudes also positively correlated with the MP1 mean sensitivity value of the corresponding visual field (P<0.01 for all groups). In the group with stable fixation or predominantly central fixation, the mean mfVEP amplitudes did not correlate with the BCVA or the MP1 mean sensitivity value. Regardless of the fixation status, the ASI was found to correlate with both the BCVA and the total MP1 mean defect value.

CONCLUSION

Objective perimetry using AccuMap mfVEP might be applied in the assessment of macular function, with the ASI offering a potentially useful indicator for evaluating macular dysfunction.

Functional retinal changes measured by microperimetry in standard-fluence vs low-fluence photodynamic therapy in chronic central serous chorioretinopathy

PURPOSE

To evaluate the effect of low-fluence photodynamic therapy (PDT) on central retinal sensitivity and fixation stability as compared with standard-fluence PDT for treating chronic central serous chorioretinopathy (CSC).

DESIGN

Prospective longitudinal follow-up of patients enrolled in a nonrandomized clinical trial of standard-fluence vs low-fluence PDT in chronic CSC.

METHODS

Forty-two eyes (42 patients) with chronic CSC were enrolled; 19 eyes received indocyanine green angiography-guided standard-fluence PDT (50 J/cm(2)) and 23 received indocyanine green angiography-guided low-fluence PDT (25 J/cm(2)). Retinal sensitivity in the central 12 degrees and fixation stability were evaluated by MP-1 microperimeter at baseline and at 3 and 12 months after PDT.

RESULTS

Mean central retinal sensitivity improved significantly at all time points (at 12 months vs baseline P < .01, Tukey-Kramer test), in the standard-fluence group from 11.9 to 14.4 at 12 months, and in the low-fluence-group from 11.8 to 16.3, with a significant difference between the 2 groups (P = .04, t test). Fixation stability did not change in either group (not significant, analysis of variance). At 12 months' follow-up the retinal sensitivity significantly correlated with best-corrected visual acuity in both groups (standard-fluence, r = -0.52, P = .02; low-fluence, r = -0.54, P = .01).

CONCLUSIONS

The study shows a significant improvement in macular sensitivity after PDT in eyes with chronic CSC, with greater efficacy in low-fluence-treated eyes. Microperimetry data suggest that low-fluence PDT may be a good treatment option in patients with chronic CSC.

Nidek MP1 is able to detect subtle decline in function in inherited and age-related atrophic macular disease with stable visual acuity

PURPOSE

To investigate whether the Nidek MP1 microperimeter (NAVIS software Version 1.7; Nidek Technologies, Padua, Italy) can detect functional decline in progressive atrophic macular disease with stable visual acuity.

METHODS

Nine eyes of nine patients with stable acuity but progressive inherited or age-related atrophic macular disease evident on fundus autofluorescence imaging were reviewed. Each patient underwent 3 consecutive microperimetry tests at baseline, 6 months, and 12 months. Acuity, fixation, and microperimetry tests were performed at each visit. Changes in acuity, fixation stability, and macular sensitivity were analyzed. To detect regional change in retinal sensitivity, the test grid was divided into clusters based on either topographical or functional features. The mean sensitivities within each zone were also compared across the three visits.

RESULTS

In this cohort, there was no significant change in visual acuity, fixation stability, and macular sensitivity over 1 year. However, significant decline in mean sensitivity within the central macula and test loci adjacent to dense scotoma was found (P = 0.004 and 0.002, respectively). In contrast, mean sensitivity elsewhere remained stable.

CONCLUSION

The MP1 can detect significant change in regional retinal sensitivity within 12 months in patients with progressive atrophic macular disease and stable acuity. Individualized analysis of regional sensitivity may be a useful method for quantifying microperimetry.

Changes in macular sensitivity after reduced fluence photodynamic therapy combined with intravitreal triamcinolone

PURPOSE

This study aimed to evaluate the course of macular sensitivity (MS) following treatment with reduced fluence photodynamic therapy (RPDT) versus standard photodynamic therapy (SPDT) in combination with intravitreal triamcinolone acetonide (IVTA) in patients with neovascular age-related macular degeneration, and to investigate the correlation between MS and angiographic outcomes.

METHODS

Forty eyes in 40 patients were included in this prospective, randomized clinical study. Group 1 patients received RPDT (n = 20, light dose of 25 J/cm(2) at 300 mW/cm(2)); group 2 patients received SPDT (n = 20, light dose of 50 J/cm(2) at 600 mW/cm(2)). All patients received 4 mg IVTA administered on the same day as RPDT or SPDT. Microperimetry, visual acuity testing (ETDRS) and fluorescein angiography (FA) were performed at baseline, and at months 3, 6, 9 and 12. Main outcome parameters were mean differential light threshold (DLT), and absolute and relative scotoma size.

RESULTS

Mean DLT decreased from 4.71 dB at baseline to 3.45 dB after 12 months in the SPDT + IVTA group (mean decrease 1.26 dB; p > 0.05) and from 5.42 dB to 4.92 dB in the RPDT + IVTA group (mean decrease 0.5 dB; p > 0.05). Absolute and relative scotoma sizes remained stable in both groups at 12 months (mean change 0 and -0.6 test-points; p > 0.05). Mean DLT values and absolute scotoma sizes correlated well with early and late leakage areas in FA (r = -0.45 to -0.80, p < 0.02).

CONCLUSIONS

With regard to MS, RPDT + IVTA did not show significant benefits over SPDT + IVTA at 12 months. Macular sensitivity correlated well with angiographic outcomes.

Microperimetric determination of retinal sensitivity in areas of dissociated optic nerve fiber layer following internal limiting membrane peeling

PURPOSE

To investigate the effects of a dissociated optic nerve fiber layer (DONFL) on retinal sensitivity.

METHODS

The medical records of 17 eyes with an idiopathic macular hole that underwent vitrectomy and internal limiting membrane (ILM) peeling were examined. All patients underwent a complete ophthalmic examination, color fundus photography, and argon blue-filter photography to determine whether a DONFL was present. The retinal function was assessed by comparing the mean retinal sensitivities in the DONFL area to those in the surrounding normal retina by static microperimetry >3 months after the surgery. The retinal sensitivities of eight regions nearest the fovea and all at the same distance from it were determined in all patients. We divided the retinal sensitivities in the two areas, that is, inside and outside the area of the DONFL, and compared each mean value.

RESULTS

Following the initial vitrectomy, the macular holes of all eyes were closed. The mean retinal sensitivities in the area of the DONFL did not differ significantly from those in the surrounding areas (P = 0.60).

CONCLUSIONS

DONFL associated with ILM peeling does not alter retinal function in the area of the DONFL as it does with a nerve fiber layer defect.

Polypoidal choroidal vasculopathy: a review

More than a quarter century has passed since the original description of polypoidal choroidal vasculopathy (PCV) in 1982 as a peculiar hemorrhagic disorder involving the macula characterized by recurrent subretinal pigment epithelial bleeding. In the ensuing years, numerous reports have described the expanded clinical spectrum of this entity. PCV is the principal vascular composition of patients of pigmented races experiencing neovascular maculopathies, particularly African Americans and Asians. This form of neovascularization is now known to occur in white patients with or without concomitant drusen, and the site of involvement has extended from the peripapillary area to the peripheral fundus. Indocyanine green angiography has made detection of these abnormal vascular changes more reliable and definitive. More precise diagnosis has also led to a better understanding of specific clinical features that distinguish PCV from more typical proliferations of abnormal choroidal vessels. We review the nature of PCV, including its genetic basis, demographic features, histopathology, clinical manifestations, natural course, response to treatments, and the histopathological and genetic bases. We emphasize multimodal ophthalmic imaging of these vessels, in particular fluorescein and indocyanine green angiography and optical coherence tomography.

Changes in visual function and thickness of macula after photodynamic therapy for age-related macular degeneration

PURPOSE

To determine the correlation between the changes in the central retinal sensitivity and the changes in the foveal thickness (FT) after photodynamic therapy (PDT) for age-related macular degeneration (AMD).

METHODS

Nineteen eyes of 19 patients with choroidal neovasularizations (CNVs) secondary to AMD were studied. The pretreatment values of the central retinal sensitivity determined by Micro Perimeter 1 (MP1; Nidek Technologies), best-corrected visual acuity (BCVA), and optical coherence tomography (OCT)-determined FT were compared to the postoperative values at three and six months after PDT.

RESULTS

At six months, the retinal sensitivity within the central 10 degrees was significantly improved (P = 0.02) and the FT was significantly thinner (P = 0.016). The BCVA, however, did not change significantly (P = 0.80). The changes in the retinal sensitivities were significantly correlated with the changes in the decrease in the FT (r = - 0.59, P = 0.012 within the central 10 degrees ) at six months after PDT.

CONCLUSION

Significant improvements in retinal sensitivities within the central 10 degrees and a decrease in FT were observed even though the BCVA was not significantly improved. The measurement of retinal sensitivity by MP1 may be a better method to assess central visual function than the conventional visual acuity after PDT.

Central retinal sensitivity after intravitreal injection of bevacizumab for myopic choroidal neovascularization

PURPOSE

To evaluate retinal sensitivity in the macular area after intravitreal injection of bevacizumab in eyes with myopic choroidal neovascularization (mCNV).

DESIGN

Prospective interventional case series.

METHODS

Twenty-two eyes of 21 patients with mCNV were treated with intravitreal injections of bevacizumab. Microperimetry in the macular area was performed with a Micro Perimeter-1 (Nidek, Vigonza, Italy) before, and at 1 month and 6 months after treatment.

RESULTS

After treatment, visual acuity (VA) and central retinal sensitivity were improved significantly. Mean VA in logarithm of the minimal angle of resolution (logMAR) fashion improved from 0.67 +/- 0.34 to 0.43 +/- 0.33 at 1 month, and to 0.34 +/- 0.26 at 6 months [P < .01, respectively]. Mean retinal sensitivity within the central 10 degree field improved from 4.8 +/- 2.8 decibels (dB) to 6.5 +/- 3.2 dB at 1 month and to 7.4 +/- 4.4 dB at 6 months [P < .01, respectively]. These improvements were more prominent in eyes with juxtafoveal mCNV than in eyes with subfoveal mCNV. With treatment, the mean number of measurement points within the scotomas decreased significantly; the absolute scotoma was reduced substantially in 15 (68%) eyes at 6 months. Unfortunately, the absolute scotoma was significantly enlarged in 1 eye (5%) at 1 month and in 4 eyes (18%) at 6 months. Also at 6 months, chorioretinal atrophy had developed in the macular area in 4 eyes (18%).

CONCLUSIONS

Although intravitreal injection of bevacizumab improved retinal sensitivity in the macular area, some eyes showed enlargement of the scotoma after this treatment.

Polypoidal choroidal vasculopathy and treatments

PURPOSE OF REVIEW

This review assesses the current knowledge of the clinical characteristics of polypoidal choroidal vasculopathy and treatments.

RECENT FINDINGS

Polypoidal choroidal vasculopathy is a disease with characteristic choroidal vascular abnormalities. Indocyanine green angiography is essential for diagnosis. The prevalence is higher in Asian people than in Caucasians. Photodynamic therapy is efficacious for treating polypoidal choroidal vasculopathy; 1-year results have shown greater benefit of photodynamic therapy than choroidal neovascularization secondary to age-related macular degeneration. Recurrence, however, seriously affects vision long term during follow-up after photodynamic therapy. The lower efficacy of bevacizumab- a full-length antibody of vascular endothelial growth factor- has been shown for polypoidal choroidal vasculopathy.

SUMMARY

Although the polypoidal choroidal vasculopathy and age-related macular degeneration have been known to share common genetic factors, its clinical characteristics including the different responses to photodynamic therapy suggest that polypoidal choroidal vasculopathy is a separate clinical entity from age-related macular degeneration. The results of photodynamic therapy for polypoidal choroidal vasculopathy are encouraging; however, recurrence may affect vision over time. Therapeutic modalities to inhibit development of the exudative choroidal vasculature of polypoidal choroidal vasculopathy are desirable.

Retinal sensitivity measured with the micro perimeter 1 after resolution of central serous chorioretinopathy

PURPOSE

To examine retinal sensitivity in the macular area of eyes with resolved central serous chorioretinopathy (CSC).

DESIGN

Retrospective chart review.

METHODS

We studied retrospectively the medical records of 21 patients (21 eyes) with resolved CSC. Using spectral-domain optical coherence tomography (SD-OCT), 6 x 6-mm areas of macula were examined with 256 sequential horizontal scans. Microperimetry in the macular area was performed with the Micro Perimeter 1 (Nidek, Vigonza, Italy). Seventy-two measurement points were located within the central 10 degrees of the macula.

RESULTS

In eyes with resolved CSC, most OCT images showed a physiologically normal appearance. However, irregularities of the retinal pigment epithelium (RPE) were detected in 11 eyes, and focal defects of the junctions between inner and outer segments (IS/OS) of the photoreceptors were noted in 15 eyes. These abnormalities often were seen within the foveal region. At 983 (79.8%) of 1,232 points with intact retina, retinal sensitivity was 16 decibels (dB) or better. However, a retinal sensitivity of 16 dB or better was obtained at 34.0% of points with irregular RPE and in 20.0% of points with defects of the IS/OS. The mean retinal sensitivities within the area with irregular RPE (13.4 +/- 4.8 dB) or with defects of the IS/OS (11.5 +/- 4.2 dB) were significantly lower than that of intact retina (17.5 +/- 2.4 dB; P < .0001).

CONCLUSIONS

Eyes with resolved CSC often show focal areas with reduced retinal function, which are consistent with irregularity of the RPE or with defects of the IS/OS.