title: Anatomic features and function of the macula and outcome of surgical tenotomy and reattachment in achiasma.
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.
  
  
  METHODS
  Case series.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Roger Johnson Clinical Vision Laboratory, Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington 98105, USA. avery.weiss@seattlechildrens.org
authors.forename: Avery H
authors.initials: AH
authors.lastname: Weiss
authors.forename: James O
authors.initials: JO
authors.lastname: Phillips
authors.forename: John P
authors.initials: JP
authors.lastname: Kelly
mesh_terms: D002648:Child; D002675:Child, Preschool; D004596:Electroretinography; D005074:Evoked Potentials, Visual / Q000502:physiology; D005133:Eye Movements / Q000502:physiology; D005260:Female; D006801:Humans; D008266:Macula Lutea / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D020417:Nystagmus, Congenital / Q000503:physiopathology*; D009897:Optic Chiasm / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D058971:Tenotomy; D041623:Tomography, Optical Coherence; D015348:Vision, Binocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology; D014794:Visual Fields / Q000502:physiology; D014795:Visual Pathways / Q000503:physiopathology