Anatomic Features and Function of the Macula and Outcome of Surgical Tenotomy and Reattachment in Achiasma

ObjectiveTo 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.DesignCase series.ParticipantsTwo children with isolated achiasma.MethodsOphthalmologic 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 MeasuresVisual acuity before and after surgery, macular anatomic features and function, and eye velocity before and after T&R surgery in 1 patient.ResultsMagnetic 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.ConclusionsThe 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.Financial Disclosure(s)The author(s) have no proprietary or commercial interest in any materials discussed in this article.