Original ArticlesMacular translocation
Introduction
The American Academy of Ophthalmology (AAO) implemented the Ophthalmic Procedure Preliminary Assessment (OPPA) in 1996 to evaluate new and rapidly evolving technology. The goal of the OPPA is to review the peer-reviewed and published scientific literature, to distill what is well established about the technology, and to help define and refine the important questions to be answered by future investigations, recognizing that emerging technology is characterized by rapid change and expanding clinical indications. Assessments are submitted to the Academy’s Board of Trustees for consideration as official Academy statements, after appropriate review by all contributors, including legal counsel.
Section snippets
Background
Age-related macular degeneration (AMD) is characterized by anatomic changes in the central retinal pigment epithelium (RPE), and is the leading cause of legal blindness among older Americans. In exudative AMD, visual loss develops as a result of choroidal neovascularization (CNV), while in atrophic or nonexudative AMD, visual loss follows atrophy of RPE and underlying choriocapillaris.
Treatments that have been proven to be effective in reducing the risk of severe vision loss for exudative AMD
Questions for assessment
The following are the key questions that are the focus of this assessment:
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Is macular translocation surgery effective in stabilizing or reversing visual loss from AMD?
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Which technique is most effective?
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What are the complications of the procedures?
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Is there any evidence that the number of complications is related to the volume of surgery that is done?
Description of evidence
The literature search that was conducted in September 1999 consisted of a text word search in MEDLINE for the years 1968–1999. The terms macular, translocation, fovea, and retina were used and results were limited to articles in English or German. The reference lists of these articles were consulted for additional citations. The search methodology included contacting ophthalmic professional organizations and obtaining abstracts from professional societies and proceedings of professional
Published results
The results of two related surgical techniques of macular translocation, categorized as those that use a 360-degree retinotomy and those use a limited retinotomy, are discussed below separately.
Conclusions
In advanced AMD, the central RPE is diseased. Macular translocation is an operation that attempts to move the central sensory retina from diseased to healthier RPE. At present, no randomized controlled trials have been conducted to study this operation. Therefore, no strong evidence to date exists with which to answer the question of whether macular translocation surgery is effective in treating visual loss from AMD, or to answer the question of which technique is most effective.
Published case
Future research
Several questions about macular translocation need to be addressed in addition to the four that are the focus of this review.
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Compared to a control group, what proportion of patients experience an improvement in or stabilization of vision from the operation?
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How many patients recover the ability to read or drive after the operation?
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What proportion of patients retain the stabilization or improvement over time?
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What is the complication rate?
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Are there subgroups of patients who are more or less
Insurance coverage
The Diagnostic & Procedure Terminology Committee (DPT) of the American Academy of Ophthalmology has determined that the appropriate CPT code for macular translocation is 67108, repair of retinal detachment; with vitrectomy, any method, with or without air or gas tamponade, focal endolaser photocoagulation, or cryo therapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique.
Appropriate diagnosis code(s) are 361.2 serous (nonrhegmatogenous) detachment and
References (13)
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Macular translocation for subfoveal choroidal neovascularization in age-related macular degenerationa prospective study
Am J Ophthalmol
(1999) - et al.
Retinotomy and foveal translocation for surgical management of subfoveal choroidal neovascular membranes
Am J Ophthalmol
(1996) - et al.
Anatomic and functional recovery of the fovea after foveal translocation surgery without large retinotomy and simultaneous excision of a neovascular membrane
Am J Ophthalmol
(1998) - et al.
Retinal separation, retinotomy, and macular relocationI. Experimental studies in the rabbit eye
Graefes Arch Clin Ophthalmol
(1993) - et al.
Retinal separation, retinotomy, and macular relocationII. A surgical approach for age-related macular degeneration?
Graefes Arch Clin Ophthalmol
(1993) - et al.
Translocation of the retina in senile macular degeneration
Schweiz Med Wochenschr
(1999)
Cited by (50)
Neovascular (Exudative or “Wet”) Age-Related Macular Degeneration
2012, Retina Fifth EditionThe use of subretinal triamcinolone acetonide in the management of neovascular age-related macular degeneration: A pilot study
2005, Canadian Journal of OphthalmologyNeovascular (Exudative) Age-Related Macular Degeneration
2005, Retina: Fourth EditionRetinal Pigment Epithelium and Photoreceptor Transplantation Frontiers
2005, Retina: Fourth EditionSurgical management of age-related macular degeneration
2005, Canadian Journal of Ophthalmology
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Prepared by the Committee on Ophthalmic Procedures Assessment Retina Panel, Donald S. Fong, MD, MPH, Chair, and approved by the American Academy of Ophthalmology’s Board of Trustees February 26, 2000.