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

Graefe's Archive for Clinical and Experimental Ophthalmology volume 242, pages 456–467 (2004)Cite this article

Abstract

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 3–4 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 than 0.1 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.

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Acknowledgements

We are indebted to Prof. E. Ungewickell and Prof. D. Grube for their critical reading of the manuscript. We are grateful to Mr. F. Hurkuck and Mr. G. Preiss for technical assistance, to Ms. A. Hundt for preparation of the photographs and to Ms. S. Fryk for linguistic correction of the manuscript.

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Affiliations

  1. Augenklinik der Städtischen Kliniken, Frankfurt a. M.-Höchst, Gotenstrasse 6–8, 65929, Frankfurt am Main, Germany

    Claus Eckardt & Ute Eckardt

  2. Abteilung Mikroskopische Anatomie im Zentrum Anatomie, Medizinische Hochschule Hannover, Hannover, Germany

    Stephanie Groos

  3. Abteilung Zellbiologie im Zentrum Anatomie, Medizinische Hochschule Hannover, Hannover, Germany

    Liliana Luciano & Enrico Reale

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  1. Claus Eckardt
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  2. Ute Eckardt
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Correspondence to Claus Eckardt.

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Eckardt, C., Eckardt, U., Groos, S. et al. Macular translocation in a patient with adult-onset foveomacular vitelliform dystrophy with light- and electron-microscopic observations on the surgically removed subfoveal tissue. Graefe's Arch Clin Exp Ophthalmol 242, 456–467 (2004). https://doi.org/10.1007/s00417-004-0922-y

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Keywords

  • Retinal Pigment Epithelium
  • Retinal Pigment Epithelium Cell
  • Lipofuscin Granule
  • Retinal Pigment Epithelium Atrophy
  • Macular Translocation