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Park, Lee, Kim, Lee, Lee, and Oum: An Analysis of Metamorphopsia Using Preferential Hyperacuity Perimeter Following Macular-off RRD Surgical Repair
Original Article

J Korean Ophthalmol Soc 2010;51(4):552-557.

Published online: 25 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.4.552

An Analysis of Metamorphopsia Using Preferential Hyperacuity Perimeter Following Macular-off RRD Surgical Repair

Hyun Jun Park, MD1, Seung Wook Lee, MD1, Kyung Ho Kim, MD1, Jung Hyun Lee, MD1, Ji Eun Lee, MD, PhD1, 2, , Boo Sup Oum, MD, PhD1, 2

1Department of Ophthalmology, Pusan National University College of Medicine, Busan, Korea

2Medical Research Institute, Pusan National University, Busan, Korea

Address reprint requests to Ji Eun Lee, MD, PhD Department of Ophthalmology, Pusan National University Hospital #1-10 Ahmi-dong, Seo-gu, Busan 602-739, Korea Tel: 82-51-240-7957, Fax: 82-51-242-7341, E-mail: jlee@pusan.ac.kr

Received 14 September 2009       Accepted 29 December 2009

Copyright © 2010 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purposse

To determine the efficacy of using the preferential hyperacuity perimeter (PHP) for the analysis of metamorphopsia following macular-off rhegmatogenous retinal detachment (RRD) surgical repair.

Methods

PHP examination was performed in those who complained of metamorphopsia after successful surgical reattachment of RRD. The subjective symptoms were evaluated based on a scale, ranging from 0 to 10, and were compared with the results of PHP examination. Patients age, duration of retinal detachment, pre and post-operative visual acuity, postoperative presence of subretinal fluid (SRF), surgical methods, presence of epiretinal membrane, and time from operation to PHP test were analyzed to find the correlation with the PHP results.

Results

Of the 19 eyes included in this study, nine eyes were found to have a hyperacuity defect upon PHP examination. In this group, the subjective level of metamorphopsia was significantly worse (p＜0.01), the age was significantly higher (p=0.02), and SRF persisted in the macula more frequently at two months postoperatively (p=0.04), as compared to those without the defect. There were no significant differences in the other factors.

Conclusions

Subjectively severe metamorphopsia after surgery for RRD could be confirmed objectively using PHP. In the case of older patients and persistent submacular fluid, metamorphopsia would develop more frequently due to displacement of the photoreceptors in the process of reattachment.

Keywords: Metamorphopsia, Preferential hyperacuity perimeter, Rhegmatogenous retinal detachment

References

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Figure 1.
(A) 54-year-old-man with inferior visual field defect in the left eye for 2 weeks, underwent scleral buckling for rhegmatogenous retinal detachment (case No. 7). After the operation, he complained of metamorphopsia. (B) Post-operative 7 months, hyperacuity defects were demonstrated in the preferential hyperacuity perimeter. The location of the hyperacuity defect is corresponded to the boundary of detachment in the macula.
jkos-51-552f1.tif
Figure 2.
(A) Normal attached retina. Red Xs represent photoreceptors located in normal position. (B) Total macular ‐off retinal detachment. Green Xs represent photoreceptors displaced position after reattachment. (C) Partial mac-ular‐off retinal detachment. Blue line indicates the boundary of the detachment.
jkos-51-552f2.tif
Table 1.
Summary of cases with hyperacuity defect in preferential hyperacuity perimetry
Case No. Age VA (logMAR)
 Sx. duration (days) Fovea off Partial macular detachment Op. method SRF* ERM† fr Duration om op. to PHP (months) Metamorphopsia scale
Preop. Postop.
1 55 1.00 0.30 7 off + B‡     8 8
2 71 1.10 0.52 20 off + V§ +   5 6
3 49 1.69 1.00 28 off   B+V + + 7 8
4 73 0.70 0.40 14 off + B     6 9
5 62 1.00 0.15 30 off   V + + 19 9
6 72 1.22 0.70 30 off   V + + 8 8
7 54 0.52 0.10 14   + B     7 6
8 57 0.70 0.30 6   + B     15 6
9 60 1.00 0.30 3 off + B +   6 6
Mean 61.4 1.00 0.42 16.9           9.0 7.3

* Subretinal fluid at 2 months after operation

† epiretinal membrane after operation

‡ scleral buckling

§ vitrectomy.

Table 2.
Summary of cases without hyperacuity defect in preferential hyperacuity perimetry
Case No. Age VA (logMAR)
 Sx. duration (days) Fovea off Partial macular detachment Op. method SRF* ERM† Duration from op. to PHP (months) Metamorphopsia scale
Preop. Postop.
10 42 0.30 0.10 14   + B‡   16 1
11 27 1.00 0.70 30 off   B   6 6
12 22 1.22 1.00 14 off   B + 16 2
13 35 0.70 0.30 7 off + B   15 6
14 58 0.40 0.20 7   + V§   16 2
15 71 0.30 0.05 5   + V + 22 2
16 74 0.52 0.20 14 off + B   15 8
17 46 0.40 0 14   + B   7 2
18 28 0.70 0.40 30 off + B   15 1
19 58 1.00 0.52 7 off   B + 12 6
Mean 46.1 0.65 0.35 14.2         14.0 3.6

* Subretinal fluid at 2 months after operation

† epiretinal membrane after operation

‡ scleral buckling

§ vitrectomy.

Table 3.
Comparison between groups with and without hyperacuity defect
  PHP (+) group* PHP (−) group† p-value
Age (years) 61.4 46.1 0.02
VA (logMAR)      
   Preop. 1.00 0.65 0.06
   Postop. 0.42 0.35 0.50
Symptom duration (days) 16.9 14.2 0.72
Fovea-off 7 6 0.28
Buckle (No.) 5 8 0.29
Vitrectomy (No.) 3 2 0.29
ERM‡ (No.) 3 2 0.33
SRF§ (No.) 5 1 0.04
Duration from op to PHP (months) 9.0 13.8 0.05
Metamorphopsia scale      
   Median 8 2 <0.01
   Minimum 6 1 –
   Maximum 9 8 –

* Group with hyperacuity defect

† group without hyperacuity defect

‡ epiretinal membrane after operation

§ subretinal fluid at 2 months after operation.

Table 4.
Sum mmary of cases with par tial macular retinal detachment in hyperacuity defect group
Case Location of detachment Fovea-off Boundary of detachment Location of
No. In the macula Fovea-off In the macula hyperacuity defect
1 Inferior off ST*, SN† ST
2 Temporal off SN. IN‡, IT§ SN
4 Temporal off SN, IN SN
7 Superior   ST, SN ST, SN
8 Superior   ST, SN ST
9 Inferior off ST, SN ST, SN, IN

* Superotemporal quadrant

† superonasal quadrant

‡ inferonasal quadrant

§ inferotemporal quadrant.

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