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Purpose: We report a case of cataract surgery in a patient with a detectable angle gamma due to macular heterotopia. Observation: A 48-year-old man had angle gamma due to macular heterotopia secondary to retinopathy of prematurity. The preoperative corrected distance visual acuity was 20/32 in the right eye and 20/200 in the left eye. Ocular deviation was esotropic at an angle of 70−80prism diopter. Only the right eye was capable of fixating due to the amblyopia in the left eye. The preoperative root mean square was measured (cornea: 1.32 μm, total: 1.64 μm in ordinary fixation position, cornea: 0.36 μm, total: 3.40 μm in pupil center position). The total aberration was lower in the ordinary fixation position than in the pupil center position. Corneal refractive power was 41.75 D in the ordinary fixation position and 43.05 D in the pupil center position. The axial lengths were 22.25 and 22.54 mm, respectively. We selected the VA60BBR intraocular lens (IOL) at +28.00 D based on the targeted fixation state. Target refraction was −1.32 D. The postoperative course was favorable, and the resulting visual acuity was 20/40. Conclusion: We report a case of cataract surgery on a patient with an angle gamma due to macular heterotopia. The postoperative course was favorable, and the patient's satisfaction was good considering that we selected the IOL's postoperative fixation state to meet the patient's occupational demands. Keywords: Macular heterotopia, Angle gamma, Cataract surgery

We report a case of an asymptomatic Caucasian male who attended our clinic for a routine check-up and macular heterotopia associated with lesions compatible with ocular toxocariasis were found.

To examine if vision in subjects with macular heterotopia (MH) secondary to retinopathy of prematurity (ROP) is related to anatomical macular structure.Six subjects with MH who were between 18 years and 65 years of age and three age-matched subjects with normal vision were recruited for the study. Vision and macular structure of the better eye of the subjects with MH and the dominant eye of age-matched subjects with normal vision were assessed. High contrast visual acuity and contrast sensitivity were measured using Early Treatment of Diabetic Retinopathy Study and Pelli-Robson charts, respectively. The Micro Perimeter (Nidek Technologies MP-1) was used to assess macular sensitivity and fixation stability. Using optical coherence tomography, macular thickness and relative retinal thickness at fixation were measured.Subjects with MH had significantly reduced visual acuity and macular sensitivity compared with age-matched subjects with normal vision. In comparison with their age-matched counterparts, subjects with MH had significantly increased macular thickness and increased relative retinal thickness at fixation. A normal foveal architecture was absent in three subjects with MH (50%).Patients with MH secondary to ROP have increased macular thickness and reduced vision.

Purpose:To study the structural sequelae and refractive outcome in eyes with a favorable structural outcome following laser treatment for threshold retinopathy of prematurity (ROP).Methods:Premature infants with threshold ROP had laser treatment with a minimum follow-up of 1 year. Complete ocular examination and refraction was done. Analysis and correlation of structural sequelae and refractive outcome was done.Results:One hundred eighty-four eyes of 93 pre-term infants were followed up. Structural changes such as vascular tortuosity, narrowing of arcades, temporal crescent, disc drag, and macular heterotopia were seen. Mean refractive error observed was −4.71 D spherical equivalent. Myopia was seen in 80.43% of eyes.Conclusions:The study revealed various structural sequelae and their correlation with refractive outcome.

The authors performed 15 vitrectomies for diabetic macular heterotopia, and then compared visual prognoses and postoperative complications with those of 88 macular detachments to determine the role of, and indications for, vitrectomy for diabetic macular heterotopia.Fifteen patients with diabetic macular heterotopia and 88 with traction macular detachment, in which the vitreous cavities were sufficiently clear for posterior poles to be observed, underwent vitrectomies. Preoperative and postoperative visual acuity and postoperative complications were assessed and documented retrospectively.There was no statistically significant difference between the two groups in terms of eyes showing improvement in visual acuity postoperatively. However, a final postoperative visual acuity better than 20/20 was documented in 93% of patients with macular heterotopia and 48% of patients with macular detachment (P0.002), whereas 47% of the former and 10% of the latter had visual acuities better than 20/40 (P0.001). Postoperative neovascular glaucoma and retinal detachment developed in 10% and 13%, respectively, of patients with macular detachments. None of the patients with macular heterotopia experienced these complications.Based on the above results, the authors conclude that diabetic macular heterotopia is a very good indication for early vitrectomy.

Macular heterotopia secondary to proliferative diabetic retinopathy has been previously reported in clinical cases. To our knowledge, we present the first clinicopathologic case of macular heterotopia in a young patient with proliferative diabetic retinopathy. The significant pathologic findings included dense fibrovascular tissue on the disc to correspond with nasal tractional retinal detachment, a superonasally displaced fovea, and an area of stripped and recoiled internal limiting membrane overlying a retinal fold. In addition, an area of reduplicated retinal pigment epithelium was noted corresponding to the clinically observed hyperpigmented area superior to the heterotopic fovea. Despite the pathologic changes, the patient maintained 20/40 visual acuity with the heterotopic fovea for several years. The findings are discussed in relation to previous clinical studies.

In seven patients with displacement of the macula in one eye caused by vitreoretinal traction from proliferative diabetic retinopathy, the macula was displaced toward the optic disk in all but one eye. The eyes with macular heterotopia showed (1) reduced visual acuity (ranging from 6/6 (20/20) to 6/24 (20/80), (2) reduced static perimetry sensitivity (particularly in the temporal field) with displacement of the peak sensitivity toward the blind spot, (3) loss of hue discrimination, and (4) metamorphopsia. In two eyes with macular heterotopia, Stiles-Crawford data provided evidence for photoreceptor disorientation; one eye had mixed orientation, and the other a displaced peak suggesting regular photoreceptor tilting. The proposed mechanisms of visual loss in eyes with macular heterotopia secondary to traction from proliferative diabetic retinopathy include detachment of the macula, disorientation of photoreceptors in the macula, and disturbance of normal neural connections within the retina caused by stretching of the retina.

A 27-year-old woman with retrolental fibroplasia developed a retinal detachment in her only eye. She demonstrated an extreme degree of nasal retinal dragging and nasal macular heterotopia.