Original articles
Limited inferior macular translocation for the treatment of subfoveal choroidal neovascularization secondary to age-related macular degeneration

This study was presented in part at the annual meeting of the Vitreous Society, Rome, Italy, September 1999.
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Abstract

PURPOSE: To review a series of patients with age-related macular degeneration undergoing limited macular translocation for the treatment of subfoveal choroidal neovascularization, to determine short-term visual acuity outcomes, to measure amounts of attainable retinal movement, and to identify prognostic factors.

METHODS: A retrospective review was conducted on a consecutive series of patients undergoing inferior limited macular translocation with scleral imbrication for the treatment of subfoveal choroidal neovascularization secondary to age-related macular degeneration. The main outcome measures investigated were distance of macular translocation, visual acuity at 3 and 6 months after surgery, change in visual acuity from baseline, and the development of intraoperative and postoperative complications. Univariate and multivariate analyses of a number of potential prognostic factors were undertaken.

RESULTS: Macular translocation was achieved in all 102 eyes (101 patients) included in this study. The range of movement varied from 200 to 2,800 μm with a median movement of 1,200 μm. Nearly 33% of the study group achieved a visual acuity better than 20/100 at 3 months, and 49% achieved this vision at 6 months. At 3 and 6 months, 37% and 48% of the study group, respectively, experienced 2 or more lines of improvement on visual acuity testing, and by 6 months 16% experienced greater than 6 lines of visual improvement. Good baseline vision, achieving the desired amount of macular translocation, a greater amount of macular translocation, and recurrent choroidal neovascularization at baseline were associated with better visual acuities at 3 and 6 months. Poor preoperative vision and the development of complications were associated with worse vision at 3 and 6 months.

CONCLUSIONS: Limited macular translocation is a technically feasible procedure that can lead to significant visual improvement and good visual acuity in some patients presenting with subfoveal choroidal neovascularization associated with age-related macular degeneration. A randomized prospective clinical trial of this surgical technique is warranted.

Section snippets

Methods

A consecutive series of patients with age-related macular degeneration undergoing limited macular translocation for subfoveal choroidal neovascularization was identified. These patients were operated on by one surgeon (Dr de Juan). Inclusion into this study required that the patient have evidence of subfoveal choroidal neovascularization on clinical examination that was confirmed on fluorescein angiography. The choroidal neovascularization had to be associated with age-related macular

Results

This study included 101 consecutive patients (102 eyes) diagnosed with subfoveal choroidal neovascularization associated with age-related macular degeneration, who underwent inferior limited macular translocation consecutively. The demographics of the study group are reported in Table 1. Patient ages ranged from 41 to 89 years with a median age of 76 years.

The choroidal neovascularization characteristics were identified with fluorescein angiography and tabulated (Table 2). Most (79%, 81 of 102)

Discussion

Current treatment options for subfoveal choroidal neovascularization associated with age-related macular degeneration are limited. At the time of this writing, laser photocoagulation remains the only proven and available treatment for subfoveal choroidal neovascularization, and the results of such treatment are routinely disappointing for the patient and physician. Without treatment, these patients typically do very poorly, with a majority experiencing severe visual loss and few maintaining

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This work was supported in part by grants from the Foundation Fighting Blindness, the Macula Vision Research Foundation, and numerous private donors.

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