Koichi Oda

Visual function after foveal translocation with 360-degree retinotomy and simultaneous torsional muscle surgery in patients with myopic neovascular maculopathy

PURPOSE To assess functional and anatomical outcomes after foveal translocation with 360-degree retinotomy and simultaneous torsional muscle surgery in patients with myopic neovascular maculopathy. METHODS Foveal translocation with 360-degree retinotomy was performed in 11 eyes of 11 patients with myopic neovascular maculopathy. Ten eyes had simultaneous torsional muscle surgery with recession of the superior oblique muscle and tucking of the inferior oblique muscle. Silicone oil removal with or without intraocular lens implantation was performed 2 to 8 weeks after the primary procedure. Visual acuity, binocular function, and degree of cyclotorsion were assessed preoperatively and postoperatively. Angles of retinal and globe rotation, distance of foveal shift, and surgical complications were also investigated. RESULTS With a mean postoperative follow-up of 6.2 months (range, 3 to 13 months), vision improved (greater than 0.2 logarithm of minimal angle of resolution [logMAR] units) in eight eyes, was unchanged in two eyes, and worsened (greater than 0.2 logMAR units) in 1 eye. Seven of 11 eyes (64%) had a final visual acuity of 20/50 or better. Five patients developed or maintained binocular fusion, four patients continued to have suppression, and two patients developed diplopia that was managed by spectacles with Fresnel prisms. Subjective cyclotorsion was less than 8 degrees in 10 eyes. Mean retinal and globe rotations were 23.4 degrees and 19.8 degrees, respectively. Average size of the choroidal neovascular membrane was 0.8 disk diameter, whereas the average distance of foveal shift was 1.5 disk diameter. After the primary procedure, three eyes developed retinal detachment, one eye macular hole, and one eye proliferative vitreoretinopathy. These complications were successfully managed by additional surgery. CONCLUSION Foveal translocation with 360-degree retinotomy is effective in restoring vision in some patients with myopic neovascular maculopathy. Although the development of torsional diplopia is generally obviated by simultaneous extraocular muscle surgery, a relatively high incidence of surgical complications should be taken into account with this procedure.

Reading ability after macular translocation surgery with 360-degree retinotomy☆

PURPOSE To report reading ability using a standardized reading chart after macular translocation with 360-degree retinotomy in eyes with age-related macular degeneration (AMD) or with myopic choroidal neovascularization (mCNV). DESIGN Interventional case series. METHODS In 34 eyes of 34 patients with subfoveal choroidal neovascular membrane (AMD, 23; mCNV, 11), macular translocation surgery with 360-degree retinotomy and simultaneous extraocular muscle surgery were performed. The average age was 67.4 +/- 7.9 years, and the average follow-up period was 7.6 +/- 3.3 months. The best-corrected far visual acuity (FVA) was measured with a standardized visual acuity chart using Landolt Cs, and the critical print size (CPS) was determined with the Japanese version of the Minnesota reading chart (MNREAD-J Chart) preoperatively and postoperatively. Preoperative and postoperative change in the CPS was compared with the subjective visual improvement as assessed by a questionnaire. RESULTS The postoperative improvement of FVA was statistically significant in eyes with mCNV (P =.010) but not significant in eyes with AMD (P =.495). The postoperative improvement of CPS was statistically significant both in eyes with AMD (P =.027) and in eyes with mCNV (P =.004). The subjective visual improvement was significantly correlated with the change of CPS in patients after a second better eye surgery. CONCLUSIONS After macular translocation with 360-degree retinotomy, the improvement of reading ability was significant in eyes with both AMD and mCNV. We conclude that this surgical method is well suited to improve reading ability of patients with AMD or mCNV.

Effective visual field size necessary for vertical reading during Japanese text processing

Eye movements were recorded during vertical reading of Japanese text. Saccade length and fixation duration were recorded as a function of moving window size, which varied in length from 1 to 12 characters vertically. Saccade length increased, and fixation duration decreased, as a function of increasing window size. Effective visual field size necessary for vertical reading was found to be approximately 5-6 character spaces in the vertical direction. This span of reading appears to be close to the size during horizontal reading of Japanese text.

Comparison of visual function after foveal translocation with 360° retinotomy and with scleral shortening in a patient with bilateral myopic neovascular maculopathy

PURPOSE To compare the visual outcome after foveal translocation by scleral shortening and that after 360 degrees retinotomy with extraocular muscle surgery in a patient with bilateral myopic neovascular maculopathy. METHODS Case report. RESULTS A 52-year-old woman with bilateral myopic neovascular maculopathy underwent foveal translocation with scleral shortening in the left eye, and visual acuity improved from 20/70 to 20/30. However, choroidal neovascularization recurred, and the final visual acuity was 20/40 after excision of the choroidal neovascularization. Foveal translocation with 360 degrees retinotomy was performed on the right eye, and visual acuity improved from 20/150 to 20/30. The critical print size was better, and the retinal sensitive area was larger in the right eye. CONCLUSION The better reading ability shown by foveal translocation by a 360 degrees retinotomy compared with scleral shortening may stem from a larger retinal sensitive area obtained by this method.

Moving window generator for reading experiments

An inexpensive PC-based moving window generator with an eye movement recording system is described. The moving window technique, activated by current eye movements, has an advantage over the fixed window technique in measuring the effective visual field size during reading. A variable rectangular window, through which the subject observes the text, is generated on a PC-controlled CRT screen. The system includes a frame buffer memory, an analog-to-digital conversion unit, and an eye movement recording system. The system works well for measuring approximate field size during reading.

Low luminance visual acuity in patients with central serous chorioretinopathy

The aim was to determine the low luminance visual acuity in eyes with central serous chorioretinopathy.

How normal eyes perform in reading low-contrast texts

PurposeTo assess the performance of normal eyes in reading low-contrast texts.MethodsWe selected 14 subjects aged 20 to 31 years (mean, 23 ± 3 years) with corrected visual acuity of 1.0 or better. The subjects were asked to read texts when the contrast between the characters and background was adjusted to 100%, 40%, 20%, and 10%. Using a computer-generated reading chart, reading acuity (RA), critical character size (CCS), and maximum reading speed (MRS) were assessed. The reading performance was compared at various contrast levels.ResultsWhen the contrast between the characters and background was 100%, 40%, 20%, and 10%, the mean RA (logMAR) was −0.08 ± 0.07, 0.03 ± 0.09, 0.13 ± 0.09, and 0.26 ± 0.11, respectively; the mean CCS (logMAR) was respectively 0.10 ± 0.09, 0.18 ± 0.09, 0.29 ± 0.14, and 0.41 ± 0.10. The mean MRS (characters/min) was 379.2 ± 41.9, 369.7 ± 43.3, 369.2 ± 60.2, and 343.7 ± 67.0, respectively. In all subjects, a decrease in contrast was associated with an increase in RA and CCS, but the MRS was not affected.ConclusionsIn normal eyes, even when reading low-contrast texts, increasing the character size makes it possible to maintain the same MRS as when reading high-contrast texts.

How Spatial Orientation of Japanese Text Affects Fixation Points in Patients with Bilateral Macular Atrophy

PurposeTo ascertain the retinal area used by patients with bilateral macular atrophy when reading Japanese text of different character sizes written horizontally or vertically. In addition, to determine fixation points as part of the first of a series of studies designed ultimately to enhance the quality of life of these patients through the improvement of reading acuity.MethodsSeventeen patients (34 eyes) with bilateral macular atrophy were tested to determine the retinal area employed for reading (R fixation point). Sentences were arranged either horizontally or vertically and projected onto the retina using a scanning laser ophthalmoscope. We also determined the fixation point using microperimetry (M fixation point). The positional relationships between these two fixation points and the scotoma were examined.ResultsThe R and M fixation points were the same in 20 of the 34 eyes. Multiple R fixation points were found in 11 eyes. The R fixation point was frequently positioned above the lesion when reading horizontally (nine eyes), while it was often positioned in the area nasal to (eight eyes) or temporal to (six eyes) the lesion when reading vertically.ConclusionsFixation points changed frequently in these patients with bilateral macular atrophy depending on the spatial orientation of the text. These data should be used in the future to help patients learn how to use the preferred retinal locus to improve their reading skills and enhance their quality of life. Jpn J Ophthalmol 2005;49:462–468 © Japanese Ophthalmological Society 2005

Reading performance with different contrast characters in patients with central serous chorioretinopathy

and he showed stable funduscopic findings at serial evaluations. Six years later, the patient was referred to our department because of VA loss in his right eye (RE) (20 ⁄ 40) and metamorphopsia. His left eye (LE) had full VA (20 ⁄ 20). On fundus biomicroscopy, the macula of the RE showed a subretinal haemorrhage inferior to the fovea associated with an elevated central yellow lesion. Fluorescein angiography in the RE showed a classic subfoveal CNV. Time-domain Stratus optical coherence tomography (OCT) was performed and revealed subfoveal tissue proliferation and subretinal fluid (Fig. 1A). After explaining different treatment options, the parents signed an informed consent and agreed to intravitreal injection of ranibizumab (Lucentis ). Intravitreal ranibizumab 0.05 ml ⁄ 0.5 mg was administered under sedation with no complications. Six weeks after injection, VA improved to 20 ⁄ 20, fundus image showed disappearance of the haemorrhage, and OCT demonstrated less oedema in the affected eye (at presentation, foveal central thickness was 486 lm, and 6 weeks after injection, it was 316 lm). During the 3-year follow-up, no signs of new recurrence or complications were observed. VA 20 ⁄ 20 in both eyes remains stable, fundus image shows a pseudohypopyon stage, and spectral-domain Cirrus OCT reveals a central foveal thickness of 191 lm (Fig. 1B). Choroidal neovascularization is a rare complication in Best’s disease. Several treatments have been reported to be effective, including laser photocoagulation, photodynamic therapy and anti– vascular endothelial growth factor (antiVEGF) injection. The use of ranibizumab for CNV in adult pathologies, such as age-related macular degeneration, has been widely validated (Rosenfeld 2006). However, in childhood, few cases reported the use of intravitreal injection of ranibizumab for CNV caused by BVMD. Recently, Querques (2008) reported a single injection of intravitreal ranibizumab to treat CNV caused by BVMD, with a VA 20 ⁄ 40 and no subsequent recurrence and no complications during the 6-month follow-up.Given the impossibility of conducting clinical trials, it is very important to demonstrate the long-term safety of these treatments in paediatric population. We also agree with Sivaprasad & Moore (2008) and Kohly (2011) who suggest creating an online registry to document the outcomes of anti-VEGF use in the management of paediatric CNV. To the best of our knowledge, this is the longest follow-up after one single intravitreal injection of ranibizumab with excellent outcomes. Despite this, the shortand long-term consequences with the use of anti-VEGF agents in children need to be further investigated.