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  • Title: Anatomic features and function of the macula and outcome of surgical tenotomy and reattachment in achiasma.
    Author: Weiss AH, Phillips JO, Kelly JP.
    Journal: Ophthalmology; 2013 Jul; 120(7):1469-75. PubMed ID: 23541762.
    Abstract:
    OBJECTIVE: To examine the anatomic features and function of the macula in achiasma and to compare visual acuity, eye movements, foveation, and eye velocity before and after tenotomy and reattachment (T&R) surgery. DESIGN: Case series. PARTICIPANTS: Two children with isolated achiasma. METHODS: Ophthalmologic examinations, brain magnetic resonance imaging, full-field and multifocal electroretinography (ERG), visual evoked potentials (VEPs), spectral-domain optical coherence tomography (OCT), eye-movement recordings, and unilateral T&R in 1 patient. MAIN OUTCOME MEASURES: Visual acuity before and after surgery, macular anatomic features and function, and eye velocity before and after T&R surgery in 1 patient. RESULTS: Magnetic resonance imaging and VEP confirmed absence of decussation of retinofugal fibers in both patients. Visual acuity was 20/100 and 20/200. The anatomic features and function of the fovea and macula were normal by OCT and multifocal ERG. After T&R, there was a marked reduction in horizontal eye velocity and monocular visual acuity improved to 20/80. CONCLUSIONS: The finding that the macula is normal in achiasma suggests that reduced acuity is the result of retinal image motion from nystagmus. Two-muscle T&R reduces horizontal retinal image motion and can improve visual acuity in achiasma or patients with infantile nystagmus.
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