Elsevier

Ophthalmology

Volume 107, Issue 5, May 2000, Pages 1015-1018
Ophthalmology

Original Articles
Macular translocation

https://doi.org/10.1016/S0161-6420(00)00082-8Get rights and content

Abstract

Objective

This document describes macular translocation surgery and examines the evidence to answer four key questions about whether the surgery is effective in treating visual loss from age-related macular degeneration, the technique that is most effective, the complications that result from the procedure, and the relationship of the volume of surgery to the number of complications.

Methods

A literature search that was conducted in September 1999 retrieved 21 relevant citations, and the reference lists of these articles were consulted for additional citations. Panel members reviewed this information, and a methodologist reviewed and rated all articles as good, fair, or poor in quality.

Results

The published literature contains only information from case series, which lack a control group and randomization. They describe a number of approaches, all of which are evolving. Follow-up is limited and visual outcomes vary widely. Serious intraoperative and postoperative complications are frequent, with accompanying risk of visual loss. Surgical morbidity is also an important factor.

Conclusions

To date no strong evidence exists with which to answer questions about the effectiveness of macular translocation surgery in treating visual loss from age-related macular degeneration or about the most effective technique. Published case series have reported a significant rate of complications. There is no evidence to date to indicate that the complication rate is related to the volume of surgery done. Randomized clinical trials are needed to determine whether macular translocation is a safe and effective treatment for visual loss from age-related macular degeneration.

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:

  • Is macular translocation surgery effective in stabilizing or reversing visual loss from AMD?

  • Which technique is most effective?

  • What are the complications of the procedures?

  • 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.

  • Compared to a control group, what proportion of patients experience an improvement in or stabilization of vision from the operation?

  • How many patients recover the ability to read or drive after the operation?

  • What proportion of patients retain the stabilization or improvement over time?

  • What is the complication rate?

  • 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)

There are more references available in the full text version of this article.

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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.

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