Original article
Macular translocation with 360 degree retinotomy for management of age-related macular degeneration with subfoveal choroidal neovascularization

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Abstract

PURPOSE: The aim of this study is to evaluate the functional outcome in a group of patients treated with full macular translocation (FMT) with 360-degree retinotomy for treatment of age-related macular degeneration (ARMD) with subfoveal choroidal neovascularization.

DESIGN: Consecutive interventional case series.

METHODS: Fifty consecutive eyes (50 patients) with ARMD and subfoveal neovascularization who underwent a FMT in our department from January 1999 to July 2000 are included in this study. Compensatory muscle surgery, as described by Eckardt and associates, was performed on all the eyes. The median follow-up is 21 months (range, 12 to 36; SD, 5.4).

RESULTS: The best-corrected postoperative visual acuity (BCVA) was improved by 2 or more Snellen lines in 33 eyes (66%) and remained stable (±1 line) in 14 eyes (28%). Only 3 eyes (6%) experienced a deterioration of the BCVA of 2 or more lines. The final BCVA was 20/50 or better in 32% of the cases; only 8 eyes (16%) had a final BCVA < 20/200. Thirty-four (68%) patients are able to read newspaper print (3.3/10) with normal (+3 diopters to +4 diopters) or increased (+5 diopters to +8 diopters) reading ads. Other patients are able to read with magnifying systems. Complications included proliferative vitreoretinopathy (PVR) in 9 eyes (18%), recurrent choroidal neovascularization in 5 eyes (10%), diplopia in 3 eyes (6%), choroidal hemorrhage in 2 eyes (4%), macular hole in 1 eye, and temporary hypotony in 1 eye.

CONCLUSIONS: As 68% of the patients in the study group regained reading vision with reading glasses, FMT can be considered an effective approach in cases of subfoveal choroidal neovascularization. Further investigations are necessary to determine which patients will have the most benefit from this complex therapeutic method.

Section snippets

Design

This study was a consecutive interventional case series.

Methods

Fifty consecutive eyes of 50 patients who underwent a macular translocation from January 1999 until July 2000 for the treatment of a subfoveal neovascularization due to ARMD are included in this study. Every other etiology was excluded. The mean age was 76 years (range, 56 to 88). All patients had suffered from a recent drop in visual acuity; most of them had been able to read newspaper print until 3 months before the operation.

All patients underwent preoperative and postoperative

Results

Figure 1 shows the preoperative and postoperative BCVA for each eye. In 33 eyes (66%) the BCVA was improved by 2 or more Snellen lines, remained stable in 14 eyes (28%), and decreased by 2 or more lines in 3 eyes (6%). Table 1 shows the preoperative and postoperative visual acuity categories in study eyes: in 32% of the patients the BCVA was 20/50 or better, only 16% had a final BCVA worse than 20/200. An important sign of visual rehabilitation is the ability to read newspaper print: 32% of the

Discussion

The aim of a macular translocation surgery is to move the macula to a healthy area of RPE and choriocapillaris so that the original physiologic environment can be reestablished. This is the reason why this approach is expected to offer a good chance of maintaining or restoring the visual acuity, provided that the macula has not suffered an irreversible damage due to the primary pathology or to the surgical trauma.

Conversely, the intense metabolic activity among macula, RPE, and choriocapillaris

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