The GAL-9 has superior psychometric properties over the GQL-15. Its only limitation is poor targeting of item difficulty to person ability, which is an inevitable attribute of a vision-related activity limitation instrument for glaucoma patients, most of whom have only peripheral visual field defects and little difficulty with daily activities.

Purpose: To analyze the correlation between morphological and functional results 12 months after epiretinal membrane (ERM) surgery. Methods: 31 eyes from 31 consecutive patients with metamorphopsia and best corrected visual acuity (BCVA) below 20/32 underwent a transconjunctival 23- gauge vitrectomy with ERM and internal limiting membrane peeling. Preoperatively and 3, 6 and 12 months postoperatively, we assessed BCVA, microperimetry (MP-1) and spectral domain optical coherence tomography (SD-OCT). Photoreceptor inner and outer segment (IS/OS) was graded on SD-OCT images and correlated with microperimetry measurements in the fovea and parafoveal region. Results: The postoperative BCVA was significantly better in eyes with an intact IS/OS junction (p < 0.01). In addition, the mean defect depth was postoperatively decreased in the foveal and parafoveal area in eyes with an intact IS/OS junction. A correlation of SD-OCT IS/OS images and microperimetry in eyes with improvement in BCVA of at least 2 lines revealed a statistically significant result for the parafoveal quadrants (p < 0.011 for SD-OCT and p < 0.005 for microperimetry) but not for the foveal area alone. Conclusions: The IS/OS regeneration in the parafoveal quadrants contributes significantly to the recovery of BCVA following ERM surgery. Consequently, functional and morphological tests of the macular area should not be limited to the fovea but should be extended to the parafoveal region.

We report a case of capsular bag distension syndrome that developed 6 years after uneventful phacoemulsification with implantation of a foldable, single-piece acrylic intraocular lens (IOL) (AcrySof MA60BM). Slitlamp microscopy revealed a deep anterior chamber with no flare or cells. The posterior capsular bag was distended by a homogeneous milky substance between the back of the IOL and the capsular bag. Using a pars plana approach, a 23-gauge bimanual capsulotomy and anterior vitrectomy were performed. Microbiological analysis revealed Propionibacterium acnes in the material inside the capsular bag. The postoperative period was uneventful. Four weeks after surgery, visual acuity was restored and there were no signs of intraocular inflammation. The origin of late capsular bag distension is not fully understood; it may involve an infectious component with propionibacteria. A surgical approach and removal of the potentially infectious material can be considered as an alternative to neodymium:YAG capsulotomy.

BackgroundTo evaluate the impact of structural changes of the retinal nerve fiber layer (RNFL), and visual field loss, on functional impairment assessed by patient-reported visual functioning in glaucoma.MethodsPatients with glaucomatous optic nerve damage were enrolled in this cross-sectional study. Peripapillary RNFL thickness was obtained with spectral-domain optical coherence tomography (SD-OCT). Function was assessed by patient-reported visual functioning using the Rasch-calibrated Glaucoma Activity Limitation 9 (GAL-9) questionnaire and standard automated perimetry. The impact of peripapillary RNFL loss on functional impairment was analyzed with correlation and linear regression analyses.ResultsA total of 176 eyes from 88 glaucoma patients were included. The SD-OCT assessed temporal-superior and temporal-inferior RNFL sector of the worse eye revealed significant correlation with the GAL-9 scores (r=-0.298, p=0.011 and r=-0.251, p=0.033, respectively). In mutivariate regression analysis, the best predictors for patient-reported visual functioning were visual acuity of the better eye and mean defect of the worse eye (R2=0.334), while structural parameters could not enhance the prediction of GAL-9 scores. ConclusionsSelf-reported visual functioning of patients with glaucoma is better predicted by visual performance data than structural parameters. However, some structural changes of the worse eye are significantly correlated with patient-reported visual functioning.

The authors report on two siblings with severe malformations of the eyes. The 16-year-old girl has bilateral microphthalmus with aplasia of the right optic nerve and a Dandy-Walker cyst of the cerebellum. The right eye has no optic disk or retinal vessels. Her 13-year-old brother has unilateral aplasia of the optic nerve with cryptophthalmus and contralateral microphthalmus. In a computer tomography examination no optic nerve could be demonstrated on the left. The presence of an oculocerebral dysplasia in a brother and sister with healthy parents suggest an autosomal-recessive mode of inheritance of the aplasia of the optic nerve with microphthalmus and/or cryptophthalmus.