Foveal translocation with scleral imbrication in patients with myopic neovascular maculopathy

https://doi.org/10.1016/S0002-9394(01)00935-7Get rights and content

Abstract

PURPOSE: To report our surgical results of foveal translocation with scleral imbrication in patients with myopic neovascular maculopathy.

DESIGN: Noncomparative, interventional, consecutive case series.

METHODS: Ten eyes of 10 myopic patients with subfoveal neovascular membranes that had undergone foveal translocation with scleral imbrication were recruited for this retrospective study. Inclusion criteria were myopia 6.0 diopters or greater in refractive error (or axial length 26.5 mm or longer), subfoveal choroidal neovascularization, and preoperative best-corrected visual acuity of 20/100 or worse. None of these eyes had undergone prior laser photocoagulation or submacular surgery. The main outcome measures were surgical complications and postoperative visual function.

RESULTS: Postoperatively, visual acuity had improved more than 3 lines in the logarithm of minimum angle of resolution (logMAR) measurement in all eyes. The mean preoperative, postoperative best, and final visual acuity were 0.12, 0.59, and 0.51, respectively. Of the 10 eyes, six achieved a postoperative final visual acuity of 20/40 or better. The mean postoperative foveal displacement was 0.78 disk diameter (range, 0.3–1.3 disk diameter). Two patients underwent a reoperation because of insufficient foveal displacement. Furthermore, one of these two patients required a third operation to reduce an excessive retinal fold involving the fovea induced by the second surgery. Of the 10 patients, two noted transient diplopia. This complaint, however, resolved over time as suppression developed. Although unintentional iatrogenic retinal tears formed intraoperatively in two eyes, these were successfully treated without serious complications. Postoperatively, mild retinal pigment epithelial changes were observed in all cases, but none led to significant deterioration of visual acuity during the follow-up period. All patients but one were followed for a minimum of 6 months.

CONCLUSIONS: In eyes with myopic neovascular maculopathy, foveal translocation with scleral imbrication may be useful in improving visual acuity. Further refinements in surgical technique and assessment of the long-term complications will be needed to make this procedure safer and more useful.

Section snippets

Methods

The records of 10 consecutive patients with myopic neovascular maculopathy who underwent foveal translocation with scleral imbrication between July 1998 and May 2000 at the Department of Ophthalmology, Niigata University Hospital, Niigata, Japan, were reviewed for this study.

Inclusion criteria were myopia 6.0 diopters or greater in refractive error (or axial length 26.5 mm or longer), subfoveal choroidal neovascularization, and preoperative best-corrected visual acuity of 20/100 or worse. None

Results

The age of the 10 patients in this study ranged from 33 to 74 years (mean, 54.8 ± 14.5 years). Of the 10 patients, nine were female and one was male. Follow-up ranged from 3 to 28 months (mean, 15.7 ± 8.2 months).

Of the 10 patients, two (patients 6 and 7) required a reoperation because of insufficient foveal displacement induced by the previous surgery. The details of one of these two patients (patient 7) are described in the case reports.

Postoperatively, the fovea was translocated by a

Case 1 (patient 1)

A 70-year-old woman with high myopia (RE: −7.0 diopters) presented with decreased vision and metamorphopsia in her right eye. The duration of her symptoms was uncertain. Best-corrected visual acuity was RE: 20/300 and LE: 20/40. On examination, the anterior segments were normal except for cortical cataracts in both eyes. Fluorescein and indocyanine green angiography of the right eye disclosed a well-defined subfoveal choroidal neovascularization surrounded with subretinal hemorrhage. Scanning

Discussion

Several studies attempted to define the natural history of choroidal neovascularization in degenerative myopia, but their results have been contradictory. It has been accepted that the choroidal neovascularization in degenerative myopia is usually self-limited. Avila and associates1 found a relatively favorable natural course of macular choroidal neovascularization. According to Hampton and associates,3 however, the natural course of choroidal neovascularization in degenerative myopia has a

References (25)

Cited by (13)

  • Choroidal neovascularization in pathological myopia

    2012, Progress in Retinal and Eye Research
  • Photodynamic Therapy vs Limited Macular Translocation in the Management of Subfoveal Choroidal Neovascularization in Pathologic Myopia: A Two-year Study

    2007, American Journal of Ophthalmology
    Citation Excerpt :

    The presence of prior laser scar in 44% of eyes, the larger size of the neovascular membrane, and the older age of patients may explain the result differences between the later and the current study. In 2001, Ichibe and associates12 reported an improvement by 3 lines or more in all 10 myopic eyes that were operated on and that had a follow-up of six months or more. In one of our previous reports comparing translocation to surgical removal of the CNV, the distribution of change in final visual acuity was in favor of translocation, with an improvement in vision by 3 lines or more in 50% of eyes after translocation vs 33% after surgical removal (P = .01).19

  • Pathologic myopia: Where are we now?

    2002, American Journal of Ophthalmology
    Citation Excerpt :

    The mean preoperative visual acuity was 20/140 (range, 20/1000 to 20/50). The LMT surgical procedure performed was similar to that described in previous reports.53,54,57,62–64 Either scleral infolding or scleral outfolding was used to shorten the sclera.

  • Latrogenic diplopia

    2014, International Ophthalmology
View all citing articles on Scopus
View full text