Macular translocation in a patient with adult-onset foveomacular vitelliform dystrophy with light- and electron-microscopic observations on the surgically removed subfoveal tissue

Graefes Arch Clin Exp Ophthalmol

(2004) 242:456467 CLINICAL INVESTIGATIONDOI 10.1007/s00417-004-0922-yClaus Eckardt

Ute Eckardt

Stephanie Groos

Liliana Luciano

Enrico RealeMacular translocation in a patient

with adult-onset foveomacular vitelliform

dystrophy with light- and electron-microscopic

observations on the surgically removed

subfoveal tissueAbstract Purpose: To correlate the

functional results of macular translocation (MT) in a patient suffering

from an adult-onset foveomacular

vitelliform dystrophy (AFVD) with

the microscopic findings of the surgically removed subfoveal retinal

pigment epithelium (RPE). Methods:

A 78-year-old woman with AFVD

underwent MT with 360 retinotomy

34 months after loss of reading

ability. Most of the vitelliform material was lost during surgery; the

subfoveal tissue was excised, fixed

in aldehydes, postfixed in reduced

OsO4 and embedded in epoxy resin.

Semithin sections were stained with

toluidine blue for light microscopy

(LM) and thin sections with uranyl

acetate and lead citrate for transmission electron microscopy (TEM).

Results: Postoperatively, the patient

developed a retinal detachment complicated by proliferative vitreoretinopathy (PVR) requiring two additional vitreoretinal procedures before finally the silicone oil could be

removed. Twenty-two months after

MT the distance visual acuity was

unchanged at 0.2; the near visual

acuity had improved from less than0.1 before MT to 0.4. The retina was

completely attached. LM and TEM

revealed serious alterations indicative

of a breakdown of the outer layer of

the retina. Conclusion: Through the

present single case it is not possible

to determine whether MT could be a

therapeutic approach in patients with

AFVD. The most important cause for

the limited postoperative visual improvement seems to be a primary

injury of the foveal function due to

the AFVD. This is supported by the

extensive subfoveal degeneration and

necrosis affecting not only the RPE

cells but also their basement membrane and the interposed basal laminar deposits.Received: 10 July 2003Revised: 1 March 2004Accepted: 1 March 2004

Published online: 11 May 2004

Springer-Verlag 2004C. Eckardt ()) U. EckardtAugenklinik der Stdtischen Kliniken,

Frankfurt a. M.-Hchst,Gotenstrasse 68,65929 Frankfurt am Main, Germany

e-mail: [email protected]

Tel.: [phone]Fax: [phone]S. GroosAbteilung Mikroskopische Anatomie

im Zentrum Anatomie,Medizinische Hochschule Hannover,

Hannover, GermanyL. Luciano E. RealeAbteilung Zellbiologie

im Zentrum Anatomie,Medizinische Hochschule Hannover,

Hannover, GermanyIntroductionMachemer and Steinhorst [27] first used macular translocation (MT) in patients with exudative age-related macular degeneration (AMD) to transpose the fovea from a

region with choroidal neovascularization (CNV) and a