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The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 1999 Apr;83(4):420–424. doi: 10.1136/bjo.83.4.420

Assessment of macular function by multifocal electroretinogram before and after macular hole surgery

Y Si 1, S Kishi 1, K Aoyagi 1
PMCID: PMC1722994  PMID: 10434863

Abstract

AIM—To evaluate macular function before and after successful surgical closure of idiopathic macular holes using multifocal electroretinogram (ERG).
METHODS—40 patients (40 eyes) with idiopathic macular holes were examined using multifocal ERG both before and after vitreous surgery. The postoperative period was from 1 to 12 months.
RESULTS—Preoperatively, the electrical retinal response densities in the foveal and the perifoveal area were apparently decreased. After a mean postoperative period of 3-6 months, the foveal and perifoveal area electrical retinal response densities improved to two to four times the preoperative level and the improvement continued to 1 year after surgery.
CONCLUSION—In macular holes, the decrease in retinal electrophysiological response was not limited to the fovea but involved an area of the perifovea of 1.6 disc diameters. The electrical retinal response density of these areas gradually improved after macular hole closure.

 Keywords: macular hole; multifocal electroretinogram; electroretinogram; retinal response density

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Figure 1  .

Figure 1  

Schema of the stimulus matrix of multifocal ERG (A), and three dimensional scalar plots of ERG responses obtained from the left eye of a normal subject (B). There is a sharp peak at the foveal area and slight depression at the optic disc (arrow).

Figure 2  .

Figure 2  

Relation between preoperative and postoperative retinal response density 6 months after surgery. Retinal response density increased in all eyes (p<0.001).

Figure 3  .

Figure 3  

Association between visual acuity and the retinal response density 6 months after surgery. A positive correlation between response density and visual acuity is seen (p<0.01). Retinal response density varied in eyes with the same visual acuity.

Figure 4  .

Figure 4  

Multifocal ERG of a 75 year old man with a stage 3 macular hole (case 1, left eye) before and after surgery. Preoperative fundus photograph (A) and multifocal ERG topography (B). Foveal and perifoveal area (areas 1 and 2) showed crater like depression. Multifocal ERG recorded at 1 month (C) and 3 months (D) postoperatively. The peak recovered in the macular area. Fundus photograph (E) and multifocal ERG topography (F) 6 months postoperatively.

Figure 5  .

Figure 5  

Fundus photograph and multifocal ERG of a 62 year old man with a stage 3 macular hole (case 2, right eye) before and after surgery. (A) Fundus photograph preoperatively. Macular hole is larger than that of the patient in case 1. (B) Multifocal ERG topography showed more widespread crater-like depression in macular area than that in case 1. Fundus photograph (C) and multifocal ERG topography (D) 6 months postoperatively. Macular hole had closed. The peak of the retinal response density was restored in macular area in the topography of multifocal ERG.    

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Acosta F., Lashkari K., Reynaud X., Jalkh A. E., Van de Velde F., Chedid N. Characterization of functional changes in macular holes and cysts. Ophthalmology. 1991 Dec;98(12):1820–1823. doi: 10.1016/s0161-6420(91)32044-x. [DOI] [PubMed] [Google Scholar]
  2. Birch D. G., Jost B. F., Fish G. E. The focal electroretinogram in fellow eyes of patients with idiopathic macular holes. Arch Ophthalmol. 1988 Nov;106(11):1558–1563. doi: 10.1001/archopht.1988.01060140726043. [DOI] [PubMed] [Google Scholar]
  3. Fish G. E., Birch D. G., Fuller D. G., Straach R. A comparison of visual function tests in eyes with maculopathy. Ophthalmology. 1986 Sep;93(9):1177–1182. doi: 10.1016/s0161-6420(86)33598-x. [DOI] [PubMed] [Google Scholar]
  4. Fish G. E., Birch D. G. The focal electroretinogram in the clinical assessment of macular disease. Ophthalmology. 1989 Jan;96(1):109–114. doi: 10.1016/s0161-6420(89)32944-7. [DOI] [PubMed] [Google Scholar]
  5. Fish G. E., Birch D. G. The focal electroretinogram in the clinical assessment of macular disease. Ophthalmology. 1989 Jan;96(1):109–114. doi: 10.1016/s0161-6420(89)32944-7. [DOI] [PubMed] [Google Scholar]
  6. Funata M., Wendel R. T., de la Cruz Z., Green W. R. Clinicopathologic study of bilateral macular holes treated with pars plana vitrectomy and gas tamponade. Retina. 1992;12(4):289–298. doi: 10.1097/00006982-199212040-00001. [DOI] [PubMed] [Google Scholar]
  7. Gass J. D. Idiopathic senile macular hole. Its early stages and pathogenesis. Arch Ophthalmol. 1988 May;106(5):629–639. doi: 10.1001/archopht.1988.01060130683026. [DOI] [PubMed] [Google Scholar]
  8. Hee M. R., Puliafito C. A., Wong C., Duker J. S., Reichel E., Schuman J. S., Swanson E. A., Fujimoto J. G. Optical coherence tomography of macular holes. Ophthalmology. 1995 May;102(5):748–756. doi: 10.1016/s0161-6420(95)30959-1. [DOI] [PubMed] [Google Scholar]
  9. Johnson R. N., Gass J. D. Idiopathic macular holes. Observations, stages of formation, and implications for surgical intervention. Ophthalmology. 1988 Jul;95(7):917–924. doi: 10.1016/s0161-6420(88)33075-7. [DOI] [PubMed] [Google Scholar]
  10. Keating D., Parks S., Evans A. L., Williamson T. H., Elliott A. T., Jay J. L. The effect of filter bandwidth on the multifocal electroretinogram. Doc Ophthalmol. 1996;92(4):291–300. doi: 10.1007/BF02584083. [DOI] [PubMed] [Google Scholar]
  11. Kishi S., Kamei Y., Shimizu K. Tractional elevation of Henle's fiber layer in idiopathic macular holes. Am J Ophthalmol. 1995 Oct;120(4):486–496. doi: 10.1016/s0002-9394(14)72663-7. [DOI] [PubMed] [Google Scholar]
  12. Kondo M., Miyake Y., Horiguchi M., Suzuki S., Ito Y., Tanikawa A. [Normal values of retinal response densities in multifocal electroretinogram]. Nippon Ganka Gakkai Zasshi. 1996 Oct;100(10):810–816. [PubMed] [Google Scholar]
  13. Kondo M., Miyake Y., Horiguchi M., Suzuki S., Tanikawa A. Clinical evaluation of multifocal electroretinogram. Invest Ophthalmol Vis Sci. 1995 Sep;36(10):2146–2150. [PubMed] [Google Scholar]
  14. Madreperla S. A., Geiger G. L., Funata M., de la Cruz Z., Green W. R. Clinicopathologic correlation of a macular hole treated by cortical vitreous peeling and gas tamponade. Ophthalmology. 1994 Apr;101(4):682–686. doi: 10.1016/s0161-6420(94)31278-4. [DOI] [PubMed] [Google Scholar]
  15. Nussenblatt R. B., Kaufman S. C., Palestine A. G., Davis M. D., Ferris F. L., 3rd Macular thickening and visual acuity. Measurement in patients with cystoid macular edema. Ophthalmology. 1987 Sep;94(9):1134–1139. doi: 10.1016/s0161-6420(87)33314-7. [DOI] [PubMed] [Google Scholar]
  16. Palmowski A. M., Sutter E. E., Bearse M. A., Jr, Fung W. Mapping of retinal function in diabetic retinopathy using the multifocal electroretinogram. Invest Ophthalmol Vis Sci. 1997 Nov;38(12):2586–2596. [PubMed] [Google Scholar]
  17. Parks S., Keating D., Williamson T. H., Evans A. L., Elliott A. T., Jay J. L. Functional imaging of the retina using the multifocal electroretinograph: a control study. Br J Ophthalmol. 1996 Sep;80(9):831–834. doi: 10.1136/bjo.80.9.831. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Seiple W. H., Siegel I. M., Carr R. E., Mayron C. Evaluating macular function using the focal ERG. Invest Ophthalmol Vis Sci. 1986 Jul;27(7):1123–1130. [PubMed] [Google Scholar]
  19. Sjaarda R. N., Frank D. A., Glaser B. M., Thompson J. T., Murphy R. P. Assessment of vision in idiopathic macular holes with macular microperimetry using the scanning laser ophthalmoscope. Ophthalmology. 1993 Oct;100(10):1513–1518. doi: 10.1016/s0161-6420(93)31448-x. [DOI] [PubMed] [Google Scholar]
  20. Sjaarda R. N., Frank D. A., Glaser B. M., Thompson J. T., Murphy R. P. Resolution of an absolute scotoma and improvement of relative scotomata after successful macular hole surgery. Am J Ophthalmol. 1993 Aug 15;116(2):129–139. doi: 10.1016/s0002-9394(14)71276-0. [DOI] [PubMed] [Google Scholar]
  21. Sutter E. E., Tran D. The field topography of ERG components in man--I. The photopic luminance response. Vision Res. 1992 Mar;32(3):433–446. doi: 10.1016/0042-6989(92)90235-b. [DOI] [PubMed] [Google Scholar]
  22. Wu S., Sutter E. E. A topographic study of oscillatory potentials in man. Vis Neurosci. 1995 Nov-Dec;12(6):1013–1025. doi: 10.1017/s0952523800006696. [DOI] [PubMed] [Google Scholar]

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