Purpose:To correlate the functional results of maculartranslocation(MT )in a patient suffering from an adult-onset foveomacular vitellif orm dystrophy(AFVD)with the microscopic findings of the surgically removed subfoveal retinal pigment epithelium(RPE).Methods:A78-year-old woman with AFVD underwe nt MT with 360°retinotomy 3-4months after loss of r eading ability.Most of the vitelliform material was lost during surgery;the subfoveal tissue was excised,fixed in aldehydes,postfixed in reduced OSO4and embedded in epoxy resin.Semithin sections were stained with toluidin e blue for light mi-croscopy(LM)and thin sections with uranyl acetate and lead citrate for transmission electron microscopy(TEM).Results:Postoperatively,the pati ent developed a retinal detachment complicated by proliferative vitreoretinopathy(PVR)requiring two additional vitreoretinal procedures before finally the silicone oil coul d be removed.Twen-ty-two months after MT the distance v isual acuity was un-changed at 0.2;the near visual acuit y had improved from less than 0.1before MT to 0.4.The retina was completely attached.LM and TEM revealed seriou s alterations in-dicative of a breakdown of the outer l ayer of the retina.Conclusion:Through the present sin gle case it is not possible to determine whether MT cou ld be a therapeutic approach in patients with AFVD.The m ost 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 affectin g not only the RPE cells but also their basement membrane and the interposed basal laminar deposits.
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