Good visual outcome after repair of a very large macular hole with neurosensory retinal operculum.

PURPOSE: To describe a favorable outcome after the surgical repair of a very large macular hole with a neurosensory operculum. METHODS: Case report. A 42-year-old man with a history of decreased vision for 3 months was found to have vision of 20/400, a very large macular hole (1159 µm in diameter), and an operculum suspended on the posterior hyaloid above the hole. RESULTS: Vitrectomy and internal limiting membrane peel were performed. The operculum was processed for histology and found to contain neurons and glial cells. Fourteen months later, the patient's vision improved to 20/60. CONCLUSION: Very large macular holes have traditionally been considered to have a poor prognosis. Here, we demonstrate that such large holes can be repaired with good visual outcome, even in the setting of an operculum consisting of avulsed neural retina.

Structural and functional implications of severe foveal dystopia in epiretinal membranes.

PURPOSE: The purpose of this study was to examine the functional and structural correlates of severe foveal dystopia in patients with epiretinal membranes. METHODS: For this retrospective study of 29 eyes with epiretinal membrane, we identified 7 eyes that had severe foveal dystopia (defined as fovea located >200 µm from its expected location) and followed the direction and rate of foveal movement pre- and postoperatively. RESULTS: Epiretinal membrane traction caused the fovea to move preoperatively at a rate of 275 µm/month from its anatomical location in 2 patients. The final preoperative foveal location was, on average, 1,217 ± 683 µm away from its expected location. Postoperatively, foveal movement toward its expected location was largest during the first month after surgery (mean = 547 ± 340 µm) and slowed down until the final follow-up position was achieved (mean = 301 ± 131 µm). Overall, the fovea moved a total of 848 ± 445 µm, allowing the fovea to correct only 32.8 ± 22.1% of the total displacement from its expected location. A univariate regression model confirmed a linear relationship between preoperative visual acuity and preoperative foveal distance from its expected anatomical location with an R of 0.759 (P = 0.0107). CONCLUSION: The extent of tractional foveal dystopia correlates with decreased visual acuity. Although all patients experienced functional and anatomical improvements with surgery, long-standing or severe foveal dystopia may be associated with permanent structural changes that limit functional outcome. Cases with extreme degrees of foveal dystopia may benefit from early intervention to prevent irreversible structural and functional changes.