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A.K. Bharadwaj, B.A. Cooper, M.A. Thomas; Limited Macular Translocation in Adult-Onset Foveomacular Vitelliform Pattern Dystrophy: A Case Report . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3054.
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Purpose: To report a case of adult-onset foveomacular vitelliform pattern dystrophy managed with limited macular translocation (LMT). Methods: A retrospective review of the patient's history, surgical intervention, and postoperative course Results: A 48-year-old male presented with a 10-year history of progressive visual disturbance left eye worse than the right eye. The patient reported a cousin with similar visual dysfunction. The patient presented with a Snellen corrected acuity of OD 20/40, OS 20/70+1. There was minimal lens opacity, and the fundi showed 1/3 disc diameter yellowish lesions OU with surrounding mild hyperpigmentation. There was less yellow material and a reddish line along the nasal aspect of the pigmented part of the lesion. Fluorescein angiography (FA) showed window-defect type hyperfluorescence OS>OD; there was no evidence of neovascularization. The patient felt his visual acuity continued to deteriorate OS>OD over the ensuing months. At 14 months after presentation, ETDRS-style best-corrected visual acuity was OD 20/25, OS 20/30. Over the next three months, ETDRS acuity fell to OD 20/40, OS 20/62. This type of dystrophy has been associated with abnormalities of the retinal pigment epithelium (RPE) which are limited to the subfoveolar RPE. We speculated that LMT might stabilize visual acuity by repositioning foveal photoreceptors over adjacent healthy RPE. After IRB approval and patient consent, LMT procedure was performed on the left eye with superotemporal scleral infolding. Surgery displaced the fovea approximately 500 microns inferior to the focal atrophic RPE lesion. At last follow up, 12 months following LMT, ETDRS visual acuity in the left eye was 20/50. Foveal fixation on the left was stable inferior to the focal atrophic RPE lesion. Conclusion: LMT was associated with stable or slightly improved visual acuity at 12 month follow up despite documented decline of visual acuity in the three months prior to surgery.
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