Skip to main content

Central mfERG amplitude ratio as a predictor for visual outcome of macular hole surgery

Documenta Ophthalmologica volume 140, pages 23–30 (2020)Cite this article

Abstract

Purpose

To investigate whether visual acuity improvement achieved after surgical treatment for macular hole (MH) can be predicted by preoperative multifocal ERG (mfERG) central/peripheral amplitude ratio.

Methods

Thirty patients with unilateral MH were included. Evaluations with comprehensive ophthalmological examination including best-corrected visual acuity (BCVA) were performed at baseline and 1, 3, 8, 24 and 48 weeks after surgery, while mfERG (Diagnosys LLC; 61 hexagons—30°) and spectral-domain optic coherence tomography (sOCT—Heidelberg Engineering) were performed at baseline and 2 months after surgery. mfERG results are shown by means of the ratio between the amplitudes’ average from rings 1 and 2 (central) and rings 4 and 5 (peripheral): the P1 ratio. mfERG data from 20 normally sighted age-matched subjects was used for comparison. A macular hole index (MH index) was defined as the quotient between hole height and base measured on OCT.

Results

Twenty-six patients finished the 48-week follow-up. Mean ± SE (logMAR) preoperative BCVA was 0.93 ± 0.22 and improved in 0.25 ± 0.07 at 48 weeks. mfERG P1 ratio was reduced at baseline and increased significantly after surgery. A significant correlation was observed between preoperative P1 ratio and BCVA gain at week 8 (r = −0.42; P = 0.033). There was no significant correlation between preoperative MH index and postoperative BCVA (P > 0.05).

Conclusion

Retinal function assessed using the ratio between central and peripheral mfERG responses might be used as predictor of visual acuity outcome after macular surgery for MH.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Steel DH, Lotery AJ (2013) Idiopathic vitreomacular traction and macular hole: a comprehensive review of pathophysiology, diagnosis, and treatment. Eye (Lond) 27(suppl 1):S1–21

    Article  Google Scholar 

  2. Steel DH, Parkes C, Papastavrou VT, Avery PJ, El-Ghrably IA, Habib MS, Sandinha MT, Smith J, Stannard KP, Vaideanu-Collins D, Hillier RJ (2016) Predicting macular hole closure with ocriplasmin based on spectral domain optical coherence tomography. Eye (Lond) 30:740–745

    CAS  Article  Google Scholar 

  3. Grinton ME, Sandinha MT, Steel DH (2015) Photoreceptor outer segment on internal limiting membrane after macular hole surgery: implications for pathogenesis. Case Rep Ophthalmol 6:339–344

    Article  Google Scholar 

  4. Matsumura T, Takamura Y, Tomomatsu T, Arimura S, Gozawa M, Kobori A, Inatani M (2016) Comparison of the inverted internal limiting membrane flap technique and the internal limiting membrane peeling for macular hole with retinal detachment. PLoS ONE 11:e0165068

    Article  Google Scholar 

  5. Jackson TL, Donachie PHJ, Sparrow JM, Johnston RL (2013) United Kingdom national ophthalmology database study of vitreoretinal surgery: report 2, macular hole. Ophthalmology 120:629–634

    Article  Google Scholar 

  6. Tognetto D, Grandin R, Sanguinetti G, Minutola D, Di Nicola M, Di Mascio R, Ravalico G, Hole Surgery Study G (2006) Internal limiting membrane removal during macular hole surgery: results of a multicenter retrospective study. Ophthalmology 113:1401–1410

    Article  Google Scholar 

  7. Nagel E, Franke E, Hary A, Hebenstreit S, Muller E, Richter S (2012) Pars plana vitrectomy for idiopathic macular hole-visual improvement or merely surgical stress? Klin Monbl Augenheilkd 229:48–51

    CAS  Article  Google Scholar 

  8. Meng Q, Zhang S, Ling Y, Cui D, Jin Y (2011) Long-term anatomic and visual outcomes of initially closed macular holes. Am J Ophthalmol 151(896–900):e892

    Google Scholar 

  9. Sun Z, Gan D, Jiang C, Wang M, Sprecher A, Jiang AC, Xu G (2012) Effect of preoperative retinal sensitivity and fixation on long-term prognosis for idiopathic macular holes. Graefes Arch Clin Exp Ophthalmol 250(11):1587–1596

    Article  Google Scholar 

  10. Grigoropoulos VG, Theodossiadis GP, Theodossiadis PG (2011) Association of the preoperative photoreceptor layer defect as assessed by optical coherence tomography with the functional outcome after macular hole closure: a long follow-up study. Ophthalmologica 225:47–54

    Article  Google Scholar 

  11. Inoue M, Watanabe Y, Arakawa A, Sato S, Kobayashi S, Kadonosono K (2009) Spectral-domain optical coherence tomography images of inner/outer segment junctions and macular hole surgery outcomes. Graefes Arch Clin Exp Ophthalmol 247:325–330

    Article  Google Scholar 

  12. Landa G, Gentile RC, Garcia PM, Muldoon TO, Rosen RB (2012) External limiting membrane and visual outcome in macular hole repair: spectral domain OCT analysis. Eye (Lond) 26:61–69

    CAS  Article  Google Scholar 

  13. Chung SE, Lim DH, Kang SW, Yoon YH, Chae JB, Roh IH (2010) Central photoreceptor viability and prediction of visual outcome in patients with idiopathic macular holes. Korean J Ophthalmol 24(4):213–218

    Article  Google Scholar 

  14. Salter AB, Folgar FA, Weissbrot J, Wald KJ (2012) Macular hole surgery prognostic success rates based on macular hole size. Ophthalmic Surg Lasers Imaging 43:184–189

    Article  Google Scholar 

  15. Almeida DR, Wong J, Belliveau M, Rayat J, Gale J (2012) Anatomical and visual outcomes of macular hole surgery with short-duration 3-day face-down positioning. Retina 32:506–510

    Article  Google Scholar 

  16. Miyake Y, Horiguchi M, Tomita N, Kondo M, Tanikawa A, Takahashi H, Suzuki S, Terasaki H (1996) Occult macular dystrophy. Am J Ophthalmol 122:644–653

    CAS  Article  Google Scholar 

  17. Piao CH, Kondo M, Tanikawa A, Terasaki H, Miyake Y (2000) Multifocal electroretinogram in occult macular dystrophy. Invest Ophthalmol Vis Sci 41:513–517

    CAS  PubMed  Google Scholar 

  18. Hood DC, Odel JG, Chen CS, Winn BJ (2003) The multifocal electroretinogram. J Neuroophthalmol 23:225–235

    Article  Google Scholar 

  19. Kim JH, Kim YM, Chung EJ, Lee SY, Koh HJ (2012) Structural and functional predictors of visual outcome of epiretinal membrane surgery. Am J Ophthalmol 153(103–110):e101

    Google Scholar 

  20. Moschos M, Apostolopoulos M, Ladas J, Theodossiadis P, Malias J, Moschou M, Papaspirou A, Theodossiadis G (2001) Multifocal ERG changes before and after macular hole surgery. Doc Ophthalmol 102:31–40

    CAS  Article  Google Scholar 

  21. Richter-Mueksch S, Vecsei-Marlovits PV, Sacu SG, Kiss CG, Weingessel B, Schmidt-Erfurth U (2007) Functional macular mapping in patients with vitreomacular pathologic features before and after surgery. Am J Ophthalmol 144:23–31

    Article  Google Scholar 

  22. Chalam KV, Murthy RK, Gupta SK, Brar VS, Grover S (2010) Foveal structure defined by spectral domain optical coherence tomography correlates with visual function after macular hole surgery. Eur J Ophthalmol 20:572–577

    Article  Google Scholar 

  23. Lois N, Burr J, Norrie J, Vale L, Cook J, McDonald A, Boachie C, Ternent L, McPherson G, Full-thickness Macular H, Internal Limiting Membrane Peeling Study G (2011) Internal limiting membrane peeling versus no peeling for idiopathic full-thickness macular hole: a pragmatic randomized controlled trial. Invest Ophthalmol Vis Sci 52:1586–1592

    Article  Google Scholar 

  24. Ternent L, Vale L, Boachie C, Burr JM, Lois N, Full-thickness Macular H, Internal Limiting Membrane Peeling Study G (2012) Cost-effectiveness of internal limiting membrane peeling versus no peeling for patients with an idiopathic full-thickness macular hole: results from a randomised controlled trial. Br J Ophthalmol 96:438–443

    Article  Google Scholar 

Download references

Funding

The study was funded by FAPESP (2011/01449-6).

Author information

Affiliations

  1. Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Prêto, SP, 14049-900, Brazil

    Renata Moreto, Ana Claudia Brancato De Lucca Perches, Felipe Almeida, Rodrigo Jorge & André Messias

  2. Department of Ophthalmology, Klinikum Stuttgart, Stuttgart, Germany

    Katrin Gekeler

Authors
  1. Renata Moreto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ana Claudia Brancato De Lucca Perches
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Felipe Almeida
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rodrigo Jorge
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. André Messias
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Katrin Gekeler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to André Messias.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants

The study protocol adhered to the tenets of the Declaration of Helsinki and was approved by the local Institutional Review Board (3566/2010).

Statement on the welfare of animals

No experiments with animals were made in this study.

Informed consent

All participants gave written informed consent before entering the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Moreto, R., De Lucca Perches, A.C.B., Almeida, F. et al. Central mfERG amplitude ratio as a predictor for visual outcome of macular hole surgery. Doc Ophthalmol 140, 23–30 (2020). https://doi.org/10.1007/s10633-019-09716-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10633-019-09716-4

Keywords

  • Macular hole
  • Multifocal electroretinography
  • ILM peeling
  • Vitrectomy