Original article
Photodynamic Therapy vs Limited Macular Translocation in the Management of Subfoveal Choroidal Neovascularization in Pathologic Myopia: A Two-year Study

https://doi.org/10.1016/j.ajo.2006.09.041Get rights and content

Purpose

To compare the results of limited macular translocation and photodynamic therapy (PDT) in subfoveal choroidal neovascularization (CNV) attributable to pathologic myopia with a 24-month follow-up.

Design

Retrospective analysis of nonrandomized interventional clinical study.

Methods

Retrospective review of 66 consecutive patients: 34 myopic eyes with subfoveal neovascularization treated by PDT and 32 operated on with the translocation technique. Translocation was considered principally when the lesion size was adequate (nasal inferior margin of the membrane less than half a disk diameter away from the center of the fovea) with duration of symptoms of less than four months. Main outcome measure was the postoperative change in visual acuity.

Results

In the translocation group, mean gain in visual acuity was greater than in the PDT group (+2.8 lines and −1.8 line, respectively, P = .001). In the translocation group, 55% of eyes gained 3 lines or more at two years compared with 10% in the PDT group. Sixty percent of eyes in the translocation group vs 40% in the PDT group had an improvement of at least five letters. Mean foveal displacement after translocation was 906 μm; postoperative complications included retinal detachment (three eyes), macular fold (one eye), and transient diplopia (four eyes). In young patients, the postoperative gain was better in both groups. In the translocation group, mean survival time for choroidal neovascularization recurrence was 40 months for patients younger than 40 years and 20 months for older patients.

Conclusions

Translocation showed better results than PDT at two years. Further studies are required to confirm these findings.

Section snippets

Methods

This study is a retrospective comparative interventional case series of consecutive patients. We reviewed the medical records of all patients who underwent either limited macular translocation or verteporfin PDT for subfoveal CNV attributable to pathologic myopia at the University Ophthalmologic Department of Créteil (France) between January 1, 1999, and December 31, 2003.

Pathologic myopia was defined either by a refractive error of 6 diopters or more or by an axial length of 26.5 mm or more.

Results

The medical records of 66 consecutive highly myopic patients treated for subfoveal CNV were analyzed; 34 eyes underwent PDT, and 32 were operated on by the translocation technique. Preoperatively, both groups were similar for age, refractive error, and gender (Table 1). But in the PDT group, visual acuity was better, CNV had a longer duration and was larger in size, probably because criteria for translocation included a short duration of the symptoms, and a limited size of the membrane. Mean

Discussion

In this study—the first, to our knowledge, to compare PDT and limited macular translocation for subfoveal CNV attributable to pathologic myopia—translocation resulted in a better central vision recovery than PDT. Despite the retrospective nature of the study, the long follow-up provides clinically useful information. At the two-year examination, 55% of eyes in the translocation group, compared with 10% in the PDT group, had an improvement of at least 3 ETDRS lines.

In the current series, results

Agnès Glacet-Bernard, MD, is in charge of the vitreo-retinal surgery unit in the Department of Ophthalmology of the University of Créteil-Paris XII, France, chaired by Gisèle Soubrane, MD, PhD, and previously run by Gabriel Coscas, MD. After a stay in Baltimore, Maryland, she has published several reports on her experience in limited macular translocation. Dr Glacet-Bernard’s favorite topics include retinal vein occlusion and macular surgery.

References (27)

Cited by (11)

  • Choroidal Neovascularization in Pathologic Myopia: Recent Developments in Diagnosis and Treatment

    2008, Survey of Ophthalmology
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    The major advantage of translocation with 360° retinotomy versus limited macular translocation seems to be the long-term preservation of improved vision.79 In addition, a 2-year comparative retrospective study demonstrated favorable results with limited macular translocation versus PDT.34 However, the Submacular Surgery Trials did not provide evidence of the efficacy of surgery in eyes with CNV due to AMD,41 and few departments are still pursuing the surgical approach.

  • Treatment of myopic choroidal neovascularization: a network meta-analysis and review

    2023, Graefe's Archive for Clinical and Experimental Ophthalmology
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Agnès Glacet-Bernard, MD, is in charge of the vitreo-retinal surgery unit in the Department of Ophthalmology of the University of Créteil-Paris XII, France, chaired by Gisèle Soubrane, MD, PhD, and previously run by Gabriel Coscas, MD. After a stay in Baltimore, Maryland, she has published several reports on her experience in limited macular translocation. Dr Glacet-Bernard’s favorite topics include retinal vein occlusion and macular surgery.

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