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Editor,—Age related macular degeneration1 is one of the leading reasons for legal blindness in the western world.2 Most therapeutic strategies, however, have so far been unsuccessful in restoring vision for the majority of patients. Recently, Robert Machemer suggested translocating the macula on healthy retinal pigment epithelium, outside the originally central region of the fundus.3 The method includes a circumferential peripheral retinotomy to mobilise the retina. The retinotomy has usually been performed by cutting the retina close to the ora serrata using scissors or the vitrectomy instrument.3-5 Using scissors can lead to complications since the underlying Bruch's membrane and the uvea can be injured. Using the vitrectomy instrument for cutting the retina leads to a loss of retinal tissue since the vitrectomy instrument works by a combined action of suction and cutting. The purpose of this study was to report on an alternative technique for circumferentially mobilising the retina.
A 87 year old woman presented with longstanding rhegmatogenous retinal detachment with proliferative vitreoretinopathy, and an additional age related macular degeneration with a 2 mm by 3 mm large disciform subfoveal membrane. A three port pars plana vitrectomy was performed. After removal of epiretinal membranes and after pars plana phakectomy, the detached peripheral retina was grasped with a microforceps, and by gentle and repeated traction, the inner layer of the pars plana epithelium was separated from the outer layer of the pars plana epithelium. Additionally, a tear was produced between the inner pars plana epithelium and the non-pigmented epithelium of the pars plicata. By regrasping and changing the position of the microforceps, the peripheral retina with the inner layer of the pars plana epithelium attached was circumferentially separated from the inner surface of the eye wall. Further surgical steps included retinal rotation, temporary injection of perfluorcarbon liquid to be replaced by silicone oil, and circumferential peripheral endolaser coagulation. The same procedure with peripheral retinorhexis was performed in the next patient aged 75 years and undergoing pars plana vitrectomy for macular rotation as treatment of age related macular degeneration.
One of the major complications of macular translocation for the treatment of age related macular degeneration is the development of proliferative vitreoretinopathy. Some of the reasons are the incision into the retina and the temporary detachment of the retina. Since the risk of proliferative vitreoretinopathy depends on the size of a retinal defect and on the area of exposed retinal pigment epithelium, one tries to perform the circumferential retinal incision with the least possible retinal destruction and least possible loss of retinal tissue. It may be accomplished by a retinorhexis using the technique described here. Retinal tissue is not lost since the tear in the tissue is located in the epithelium of the pars plana peripheral to the ora serrata. Consequently, retinal pigment epithelium is not, or only slightly, exposed. It may reduce the risk of postoperative proliferative vitreoretinopathy.
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