UNASSIGNED: SMART syndrome is a rare complication of brain radiotherapy. This is the first described presentation of SMART syndrome with metamorphopsia, which responded to aspirin, verapamil, and high-dose L-arginine therapy.
UNASSIGNED: A 43-year-old man presented with 3 weeks of migraine headaches with metamorphopsia and complex visual hallucinations affecting the left lower quadrant of both visual fields. This occurred on a background of high-dose radiotherapy for right cerebellar astrocytoma 32 years ago. MRI brain demonstrated unilateral gyriform enhancement and FLAIR hyperintense cortical swelling in the right occipital lobe consistent with SMART syndrome.
UNASSIGNED: Unusual presentations of SMART syndrome exist and require consideration in all patients with focal neurological deficit post-brain radiotherapy. Validated diagnostic and treatment modalities for SMART syndrome are urgently required.

BACKGROUND: The aim of the study was to determine the prevalence of metamorphopsia following rhegmatogenous retinal detachment (RRD) surgery, as well as associated predictive factors.
METHODS: A total of 107 eyes successfully operated for RRD underwent metamorphopsia severity assessment using M-CHARTS, and foveal microstructure analysis by spectral domain optical coherence tomography, at 1 and 6 months postoperatively. Univariate and multivariate logistic regression rendered evaluation of preoperative risk factors. The correlation between metamorphopsia score and outer retinal layer (ORL) integrity was investigated and preoperative risk factors evaluated.
RESULTS: The prevalence of postoperative metamorphopsia decreased from 51.4 to 29.9% and the median metamorphopsia score significantly improved (0.5, 95% CI: 0.3; 0.9, to 0.2, 95% CI: 0; 0.5, p < 0.001) from 1 to 6 months, respectively. Preoperative macular detachment was the only predictor found (OR 11.0, 95% CI: 3.1; 39.4, p < 0.001). Metamorphopsia severity was significantly associated with outer nuclear layer thickness and the status of the ellipsoid and cone interdigitation zones. One-month M-CHARTS had 81% sensitivity and 87% specificity in predicting full metamorphopsia recovery at 6 months (0.45 cut-off score).
CONCLUSIONS: The prevalence of metamorphopsia decreased in parallel to ORL restoration, thus demonstrating the etiological role of photoreceptor-level morphological changes. M-CHARTS allowed for monitoring and predicting metamorphopsia recovery after RRD.

This study aimed to evaluate visual function and perform multimodal imaging on patients with focal choroidal excavation without any chorioretinal disease (idiopathic focal choroidal excavation [iFCE]). Seventeen eyes of 15 patients with iFCE (8 men, 7 women; mean ± standard deviation age, 56.0 ± 10.8 years) were assessed for visual function including visual acuity, metamorphopsia, aniseikonia, and retinal sensitivity. Multimodal imaging included optical coherence tomography (OCT), fundus autofluorescence (FAF), and OCT angiography. This study found that the maximum width and depth of the excavation were 597 ± 330 (238-1809) µm and 123 ± 45 (66-231) µm, respectively, and that FAF showed normal or hypoautofluorescence corresponding to iFCE. The fundus examination findings were stable during the follow-up period (96 ± 48 months). None of the eyes showed any abnormalities in central retinal sensitivity or aniseikonia. Metamorphopsia was detected using Amsler grid testing and M-CHARTS in two eyes. Therefore, this study is the first to quantitatively and qualitatively study metamorphopsia of patients with iFCE. Our results showed that most patients with iFCE did not have visual impairments, despite the presence of morphological changes in the outer retina and choroid.

An epiretinal membrane (ERM) is a frequently occurring disease affecting the macula, which can be associated with visual impairment and metamorphopsia, depending on the severity and location. A distinction is made between an idiopathic form caused by age-related changes of the vitreous body and a secondary form associated with diseases of the posterior segment. The development of fibrocellular epiretinal membranes formed by dedifferentiation of intraretinal and extraretinal cells at the level of the vitreomacular interface plays a major role in the pathogenesis. The diagnostics and indications for surgical treatment of ERM are based on the visual acuity, evidence of metamorphopsia, ophthalmoscopic findings and optical coherence tomography (OCT) of the macula. In addition to the possibility of observation of the course where benign spontaneous courses are not uncommon, pars plana vitrectomy (PPV) with peeling of the ERM and internal limiting membrane (ILM) to prevent recurrences is the treatment of choice in symptomatic patients. The prognosis after surgical treatment is very good. In approximately two thirds of the cases, an improvement in visual acuity and/or a reduction of metamorphopsia can be achieved, with a number of predictive, primarily OCT-based factors enabling a prediction of the functional prognosis. Comprehensive patient education regarding the generally long duration of postoperative rehabilitation and the possibility of persistent symptoms or visual deterioration despite successful membrane removal is essential.
UNASSIGNED: Die epiretinale Gliose ist eine häufig auftretende Erkrankung der Makula, die je nach Ausprägung und Lokalisation mit einer Verschlechterung der zentralen Sehschärfe und Metamorphopsie einhergehen kann. Dabei wird zwischen einer idiopathischen, durch altersbedingte Glaskörperveränderungen entstehenden und einer sekundären, mit Erkrankungen des hinteren Augenabschnitts assoziierten Form unterschieden. Eine entscheidende Rolle in der Pathogenese spielen fibrozelluläre epiretinale Membranen (ERM) im Bereich der vitreomakulären Grenzfläche, die durch Dedifferenzierung intra- und extraretinaler Zellen entstehen. Diagnostik und Indikationsstellung zur operativen Therapie der epiretinalen Gliose basieren auf Visusbestimmung, Nachweis der Metamorphopsie, ophthalmoskopischem Befund sowie optischer Kohärenztomographie (OCT) der Makula. Neben der Möglichkeit einer Verlaufsbeobachtung bei nicht selten benignen Spontanverläufen stellt die Pars-plana-Vitrektomie (PPV) mit Peeling der ERM und Membrana limitans interna (ILM) zur Vermeidung von Rezidiven die Therapie der Wahl dar. Insgesamt gilt die Prognose nach operativer Versorgung als sehr gut. In etwa zwei Dritteln der Fälle kann eine Verbesserung des Visus und/oder Reduktion der Metamorphopsie erreicht werden, wobei eine Reihe prädiktiver, v. a. OCT-basierter Faktoren eine Aussage hinsichtlich der funktionellen Prognose zulässt. Aufgrund der häufig lang dauernden postoperativen Rehabilitation sowie der Möglichkeit einer trotz erfolgreichen Membranpeelings möglichen Beschwerdepersistenz oder Sehverschlechterung ist eine entsprechende umfassende Patientenaufklärung essenziell.

OBJECTIVE: We aimed to quantitatively evaluate metamorphopsia pre- and postoperatively in patients with idiopathic epiretinal membrane(iERM) using M-CHARTS™ and to evaluate the relationship between morphological changes in retinal layers on optical coherence tomography (OCT) and metamorphopsia scores.
METHODS: This prospective study included 42 patients followed in Akdeniz University Hospital Ophthalmology Clinic diagnosed with iERM by fundus examination and OCT between 2020-2022. Detailed ophthalmologic findings, visual acuities, metamorphopsia scores, and OCT parameters of all patients were recorded. The relationship between pre- and postoperative visual acuity, metamorphopsia scores and OCT parameters was investigated. Changes in OCT parameters were compared by evaluating patients with stable or increasing metamorphopsia scores as one group (group1) and patients with decreasing metamorphopsia scores as the other group (group 2).
RESULTS: In \"group 2\", preoperative Ganglion Cell Layer+Inner Plexiform Layer (Central) (GCL+IPL (C)) was significantly (P: 0.028) higher than in \"group 1\".
CONCLUSIONS: A statistically significant preoperative thickness difference in the OCT parameters of the GCL+IPL (C) layer was associated with the quantitative metamorphopsia complaints of the patients. The thickness of the preoperative GCL+IPL (C) layer can be considered an important indicator of symptoms of metamorphopsia determining functional success after surgery.

BACKGROUND: The aim of this study was to investigate the efficacy of new monofocal intraocular lens (IOL) in comparison with conventional monofocal IOL in patients undergoing combined cataract and vitrectomy surgery for epiretinal membrane (ERM).
METHODS: This prospective non-randomized comparative study included 65 eyes of 65 patients who underwent combined cataract and vitrectomy for ERM with implantation of advanced monofocal IOL (Eyhance ICB00, 33 patients) and standard monofocal IOL (Tecnis ZCB00, 32 patients). Monocular visual acuities were measured 6 months post-operatively, including corrected and uncorrected distance visual acuity (CDVA, UCDVA), uncorrected intermediate visual acuity (UCIVA), and uncorrected near visual acuity (UCNVA). Furthermore, contrast sensitivity and metamorphopsia were measured.
RESULTS: There was no significant difference between two groups regarding operation time, post-operative CDVA, UCDVA, UCNVA, and spherical equivalent (p > 0.05). Monocular UCIVA was significantly higher in the Eyhance IOL group than in the Tecnis IOL group (p = 0.005). The photopic and mesopic contrast sensitivities were comparable between each group for any spatial frequency (p > 0.05). The correlation coefficients from correlations between retinal wrinkling ratio and M score did not differ significantly between groups (p = 0.877), and the degree of metamorphopsia was not significantly related to the type of IOL (p = 0.969).
CONCLUSIONS: In combined cataract and vitrectomy for ERM, Eyhance IOL provided significant better visual performance at intermediate distance than standard monofocal IOL without compromising operation time, distance vision, contrast sensitivity, and evaluating metamorphopsia. Eyhance IOL can be a useful option for both surgeons and patients.

BACKGROUND: We compared postoperative metamorphopsia and optical coherence tomography (OCT) findings between eyes that underwent internal limiting membrane (ILM) peeling and the inverted flap (IF) technique for macular hole (MH).
METHODS: This retrospective analysis included 64 eyes of 64 patients with idiopathic MH whose MH was closed after initial surgery. Thirty-nine patients were treated with pars plana vitrectomy (PPV) with ILM peeling, and 25 patients were treated with PPV with the IF technique. Best corrected visual acuity (BCVA), severity of metamorphopsia, and OCT images were collected before and 3, 6, and 12 months postoperatively. Based on the OCT images, the status of the external limiting membrane (ELM) and ellipsoid zone and the presence of hyperreflective plugs were assessed.
RESULTS: At baseline and 3, 6, and 12 months postoperatively, BCVA and severity of metamorphopsia were not significantly different between groups. The status of the ELM was significantly worse in the IF group than in the ILM peeling group at 3 and 6 months postoperatively. Significantly more hyperreflective plugs were observed in the IF group than in the ILM peeling group at 3 and 6 months postoperatively. Stepwise multiregression analysis revealed that hyperreflective plugs were significantly associated with the severity of metamorphopsia at 12 months postoperatively.
CONCLUSIONS: The alterations on the OCT were fewer in the ILM peeling group than in the IF group, while no significant differences were observed in postoperative severity of metamorphopsia between groups. Metamorphopsia was worse in eyes with hyperreflective plugs.

OBJECTIVE: To quantify and compare the severity of metamorphopsia in patients undergoing vitrectomy for vitreoretinal disorders.
METHODS: Data were collected evaluated from 319 patients with vitreoretinal disorders, including epiretinal membrane (ERM), macular hole (MH), cystoid macular edema with branch retinal vein occlusion (BRVO-CME), CME with central retinal vein occlusion (CRVO), diabetic macular edema (DME), macula-off rhegmatogenous retinal detachment (M-off RD), and macula-on RD (M-on RD). Metamorphopsia was recorded with the M-CHARTS preoperatively and at 3 and 6 months postoperatively.
RESULTS: Preoperative and 6-month postoperative metamorphopsia scores were 0.69 ± 0.50 and 0.50 ± 0.52, respectively. Before surgery, 94% of patients presented with metamorphopsia (score ≥0.2). Preoperative metamorphopsia scores were significantly correlated with postoperative metamorphopsia scores (r = 0.378, p < 0.0001). Preoperative metamorphopsia score was significantly higher for ERM (0.89) than for DME (0.51). Vitrectomy significantly improved metamorphopsia in ERM and MH but not in the other disorders. In contrast, treatment improved visual acuity for all disorders except CRVO-CME and M-on RD.
CONCLUSIONS: This quantitative study indicated that metamorphopsia is present in most patients undergoing surgery for vitreoretinal diseases and is most severe in ERM. In these patients, vitrectomy improved visual acuity but not metamorphopsia.

BACKGROUND: Idiopathic epiretinal membrane (iERM) is a common disorder of the vitreomacular interface characterized by decreased visual acuity and metamorphopsia. This study aimed to analyze the association between the anatomical change of the retina and functional outcomes in iERM patients so as to derive the prognostic factors of visual acuity (VA) and metamorphopsia.
METHODS: Forty-five patients (one eye per patient; 45 eyes in total) who underwent pars plana vitrectomy and membrane peeling for iERM by a single surgeon were enrolled in this retrospective study. The results on best-corrected visual acuity (BCVA) and metamorphopsia as well as retinal images were obtained before the surgery and 1, 3, 6 months after the surgery. The BCVA and retinal microstructure, including central retinal thickness (CRT), ganglion cell layer (GCL) thickness, inner nuclear layer (INL) and outer nuclear layer + outer plexiform layer (ONL+OPL), and continuity of photoreceptor inner/outer segment (IS/OS) junction before and after iERM surgery were compared using paired samples t-test (continuous variables) or Chi-square test (categorical variables). Multiple regression analysis was carried out to explore the association among BCVA, M-score, and the parameters derived from optical coherence tomography.
RESULTS: Compared with preoperative data, a significant improvement in BCVA was observed 1, 3, and 6 months postoperatively (t = 5.37, p < 0.0001; t = 7.29, p < 0.0001; t = 6.44, p < 0.0001 for 1, 3, and 6 months postoperatively, respectively), whereas the M-score only decreased significantly 3 and 6 months after the surgery (t = 2.36, p = 0.02; t = 5.00, p < 0.0001, respectively). In comparison with the baseline, the CRT, INL, and ONL+OPL thickness showed a significant decrease at each postoperative follow-up time, and GCL thickness (t = 3.86, p = 0.0002) and IS/OS disruption ratio (χ2 = 4.86, p = 0.027) were markedly reduced only 6 months postoperatively. Six-month postoperative BCVA was considerably associated with preoperative CRT and ONL+OPL thickness, as well as postoperative CRT, ONL+OPL thickness, and severity of IS/OS disruption. Moreover, the M-score after surgery was markedly correlated with both the preoperative and postoperative INL and CRT thickness.
CONCLUSIONS: Both VA and M-score in iERM patients were significantly improved after vitrectomy. Pre- and post-operative CRT was significantly associated with both postoperative BCVA and M-score. Besides, pre- and post-operative INL thickness was correlated to postoperative metamorphopsia, and postoperative BCVA was associated with postoperative ONL+OPL thickness and IS/OS integrity.

Alice in Wonderland syndrome (AIWS) is extremely rare, occurring more often in young individuals than in older adults. Symptoms of this syndrome typically include an altered body image, size perception, and time perception. However, the pathophysiology and lesions responsible for this syndrome remain unclear. In most cases, specific lesions cannot be identified using computed tomography or magnetic resonance imaging. Two patients with isolated cortical venous thrombosis in the right occipital area experienced transient visual symptoms of AIWS. Furthermore, a literature search indicated that AIWS with visual distortions is associated with right occipital lobe lesions, supporting the findings of our study.