Original Articles
Macular translocation for subfoveal choroidal neovascularization in age-related macular degeneration: a prospective study

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Abstract

PURPOSE: To conduct a prospective study of macular translocation in patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration.

METHODS: In 10 eyes of 10 patients with subfoveal choroidal neovascularization and best-corrected visual acuity ranging from 20/50 to 20/800 (median, 20/111), the fovea was relocated by means of scleral imbrication, intentional retinal detachment with small posterior retinotomies, and partial fluid-air exchange. In two eyes, the choroidal neovascular membranes were removed at the time of macular translocation; in seven eyes they were photocoagulated in the postoperative period; and in one eye the membrane was removed during reoperation to unfold a macular fold.

RESULTS: All 10 eyes were followed up for 6 months. The median postoperative foveal displacement was 1286 μm (range, 114 to 1,919 μm). In three eyes (30%), a foveal fold formed postoperatively requiring reoperation, with one of these eyes requiring a second reoperation for a rhegmatogenous retinal detachment. Best-corrected visual acuity improved in four eyes (median, 10.5 letters) and decreased in six eyes (median, 14.5 letters). The median change in visual acuity was a decrease of 5 letters. The final best-corrected visual acuity was 20/80 in two eyes, 20/126 in one eye, 20/160 in four eyes, 20/200 in one eye, 20/250 in one eye, and 20/640 in one eye.

CONCLUSIONS: Our initial experience with limited macular translocation suggests that this surgical technique is unpredictable. However, in patients with subfoveal choroidal neovascularization from age-related macular degeneration, it offers the potential for improving visual function and may be associated with less loss of vision than the disease itself, if allowed to progress. Further refinements in surgical indications and technique are needed to make this procedure safer, more predictable, and more beneficial.

Section snippets

Patients and methods

Patients examined at The Cole Eye Institute of the Cleveland Clinic Foundation were eligible to participate in the study if they met the following inclusion criteria: (1) age 60 years or older, (2) best-corrected visual acuity between 20/50 and 20/800 in the eligible eye, (3) evidence of drusen in both eyes, and (4) age-related macular degeneration with new or recurrent choroidal neovascularization that involved the geometric center of the foveal avascular zone and that measured 6 Macular

Results

Of the 10 patients, five were men and five were women (Table 1). Their ages ranged from 66 to 86 years (median, 77 years). The patients were referred for treatment of choroidal neovascularization from age-related macular degeneration and had a history of blurred vision or metamorphopsia in the affected eye for 7 to 365 days (median, 111 days). The operated-on eye was the right eye in six patients and the left eye in four patients. The fellow eye showed drusen in 10 patients, geographic atrophy

Discussion

Age-related macular degeneration is the leading cause of irreversible visual loss in the western hemisphere. Approximately 10% to 20% of patients with age-related macular degeneration develop the exudative form of the disease, characterized by choroidal neovascularization.12, 13 It is estimated that in the United States, 100,000 to 200,000 people develop choroidal neovascularization every year.14 Currently, the only beneficial treatment for choroidal neovascularization is photocoagulation, as

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