Foveal translocation for exudative age related macular degeneration

The idea that the macular neurosensory retina might be surgically detached and then reattached in such a manner that the fovea is relocated on the underlying retinal pigment epithelium (RPE) and choroid has been attributed to Lindsey et al.1 However, the 1983 ARVO abstract did not make clear that the main purpose of this exercise was to restore vision in eyes with subfoveal choroidal neovascular membranes (CNVMs) complicating age related macular degeneration (AMD), and the experimental and theoretical potential of the method was first realised clinically by Machemer and Steinhorst2 only in 1993. Their “macular rotation” procedure comprised induction of retinal detachment, vitrectomy and 360° peripheral retinotomy, removal of the CNVM (and any associated subretinal haemorrhage), and 30–80° rotation of the retina around the axis of the optic nerve before silicone oil injection and 360° endolaser retinopexy. Of the three eyes so treated, one showed a major visual improvement while proliferative vitreoretinopathy (PVR) compromised the outcome in the other two eyes. Modifications of the macular rotation method then followed3-6 but only Eckardt and colleagues from Frankfurt6 have succeeded in perfecting the technique, including minimising PVR and simultaneously counterrotating the globe to avoid a tilted image. …