Changes of the triple flash electroretinogram after 360 degrees retinotomy and macular translocation for subfoveal choroidal neovascularisation in age-related macular degeneration

BACKGROUND: The aim of the present study was to evaluate potential electrophysiological changes after 360 degrees retinotomy and macular translocation for subfoveal choroidal neovascularisation in patients with age-related macular degeneration. METHODS: A consecutive series of 32 patients suffering from subfoveal choroidal neovascularisation secondary to age-related macular degeneration underwent 360 degrees retinotomy and macular translocation. The scotopic triple-flash ERG (TERG) served as the main parameter of the study and was recorded one day prior to the translocation surgery and no earlier than 4 weeks after the silicone oil removal. RESULTS: The TERG amplitudes were significantly reduced after translocation surgery. Depending on the applied flash luminance the mean amplitude reduction of the first b-wave varied between 67 % (0.2 cds/m (2)) and 74 % (0.03 cds/m (2)). The latency of the second b-wave of the preoperative TERG proved to have predictive power with reference to the postoperative visual acuity. A statistically significant correlation between the latency of the second b-wave for a flash intensity of 0.03 and 0.1 cds/m (2) and the postoperative visual acuity was shown (p = 0,016 and p = 0,049). CONCLUSIONS: In accordance with previous studies the present study indicates that a significant electrophysiological decrease is caused by surgical procedures associated with macular translocation. In future, due to predictive parameters of the TERG the preoperative selection of patients could be improved.     

Changes in focal macular ERGs after macular translocation surgery with 360 degrees retinotomy

PURPOSE: To evaluate the short- and long-term changes of focal macular electroretinograms (fmERGs) after macular translocation with 360 degrees retinotomy. METHODS: This was a retrospective study. fmERGs were recorded in 19 eyes of 19 consecutive patients who underwent macular translocation with 360 degrees retinotomy for choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD; 17 eyes) or polypoidal choroidal vasculopathy (2 eyes). The changes in the fmERGs, recorded before, shortly after (6-12 months; mean 8.3 months), and more than 18 months (18-30 months; mean 22.4 months) after surgery from 12 eyes, were analyzed. A 15 degrees stimulus centered on the fovea was used to elicit the fmERGs. RESULTS: The mean logarithm of minimum angle of resolution (logMAR) was 1.06 +/- 0.07 (20/230) before surgery, 0.78 +/- 0.08 (20/121) early after surgery (n = 19), and 0.64 +/- 0.07 (20/87) late after surgery (n = 12). These improvements in visual acuity were significant (P = 0.0074, P = 0.0050, respectively). Before surgery, the amplitudes of all components of the fmERGs were markedly reduced in all eyes. The mean b-wave amplitude in 17 AMD eyes recorded early after surgery was significantly larger (P = 0.0262), and the mean a-wave amplitude was also increased but not significantly (P = 0.1180). The mean amplitudes of the a- and b-waves in 10 AMD eyes recorded after 18 months were significantly larger than those before the surgery (P = 0.0218, and P = 0.0284). The mean implicit time of the b-wave in 17 AMD eyes decreased early after surgery, and a further decrease was detected at the later testing time. CONCLUSIONS: These results indicate that macular function is partially recoverable after macular translocation in some patients.     

Reading ability after macular translocation surgery with 360-degree retinotomy

PURPOSE: To report reading ability using a standardized reading chart after macular translocation with 360-degree retinotomy in eyes with age-related macular degeneration (AMD) or with myopic choroidal neovascularization (mCNV). DESIGN: Interventional case series. METHODS: In 34 eyes of 34 patients with subfoveal choroidal neovascular membrane (AMD, 23; mCNV, 11), macular translocation surgery with 360-degree retinotomy and simultaneous extraocular muscle surgery were performed. The average age was 67.4 +/- 7.9 years, and the average follow-up period was 7.6 +/- 3.3 months. The best-corrected far visual acuity (FVA) was measured with a standardized visual acuity chart using Landolt Cs, and the critical print size (CPS) was determined with the Japanese version of the Minnesota reading chart (MNREAD-J Chart) preoperatively and postoperatively. Preoperative and postoperative change in the CPS was compared with the subjective visual improvement as assessed by a questionnaire. RESULTS: The postoperative improvement of FVA was statistically significant in eyes with mCNV (P =.010) but not significant in eyes with AMD (P =.495). The postoperative improvement of CPS was statistically significant both in eyes with AMD (P =.027) and in eyes with mCNV (P =.004). The subjective visual improvement was significantly correlated with the change of CPS in patients after a second better eye surgery. CONCLUSIONS: After macular translocation with 360-degree retinotomy, the improvement of reading ability was significant in eyes with both AMD and mCNV. We conclude that this surgical method is well suited to improve reading ability of patients with AMD or mCNV.     

Electro-oculographic findings after 360° retinotomy and macular translocation for subfoveal choroidal neovascularisation in age-related macular degeneration

Purpose To evaluate potential electro-oculographic changes after 360° retinotomy and macular translocation for subfoveal choroidal neovascularisation in patients with age-related macular degeneration (AMD) in a randomised comparative (self-controlled) trial.Methods A consecutive series of 30 patients suffering from subfoveal choroidal neovascularisation secondary to age-related macular degeneration underwent 360° retinotomy and macular translocation. The EOG served as the main parameter of the study and was recorded 1 day prior to the translocation surgery and no earlier than 21 days after the silicone oil removal.Results Postoperatively, a statistically significant decrease in mean dark trough by 64% was found for treated eyes (P<0.001). The mean dark trough of the fellow eye remained stable after surgery (P=0.33). The postoperative difference between the treated und untreated eyes proved to be statistically significant (P<0.001). The Arden ratio remained stable in the treated and untreated eyes with mean values of 204% (P=0.81) and 213% (P=0.18), respectively. A significant correlation between the reduction of the dark trough and the visual acuity at the 1-year follow-up was found.Conclusions A persistent decrease in the corneofundal potential is associated with 360° retinotomy and macular translocation for exudative AMD. This indicates a substantial postoperative malfunction of retinal pigment epithelial cells and an impaired photoreceptor regeneration. The impeded recovery of the RPE-photoreceptor complex can be interpreted as the result of the surgical trauma on the basis of prediseased RPE. A severe postoperative decrease in dark trough forecasts an incomplete recovery of visual acuity.     

Successful photodynamic therapy with verteporfin for recurrent choroidal neovascularization beneath the new fovea after macular translocation surgery with 360-degree retinotomy

PURPOSE: To report a case of successfully treated recurrent choroidal neovascularization after macular translocation surgery with 360-degree retinotomy by photodynamic therapy with verteporfin. DESIGN: Interventional case report. METHODS: A 76-year-old man developed recurrent choroidal neovascularization at the new fovea after macular translocation surgery with 360-degree retinotomy. RESULTS: Two sessions of photodynamic therapy were applied, which resolved the choroidal neovascularization. Best-corrected visual acuity improved to 20/50 at the 6 and 12 months follow-up. CONCLUSION: Photodynamic therapy may be an option for treatment of recurrent choroidal neovascularization in the new subfoveal region after macular translocation surgery with 360-degree retinotomy.     

Macular translocation with 360° retinotomy for retinal pigment epithelial tear

PURPOSE: To report a case of retinal pigment epithelial tear treated by macular translocation with 360 degrees retinotomy. METHODS: Interventional case report. A 75-year-old woman with neovascular age-related macular degeneration and retinal pigment epithelial tear underwent macular translocation with 360 degrees retinotomy and silicone oil tamponade. After 3 months, pars plana vitrectomy, silicone oil removal, and muscle surgery were performed. RESULTS: Twenty-two months after macular translocation surgery, the visual acuity of the patient had improved to 20/50 (preoperative 20/200). No proliferative vitreoretinopathy or recurrence of the choroidal neovascularisation was observed. CONCLUSIONS: Macular translocation surgery with 360 degrees retinotomy can improve vision in retinal pigment epithelial tear secondary to neovascular age-related macular degeneration.     

Comparison of three techniques of foveal translocation in patients with subfoveal choroidal neovascularization resulting from age-related macular degeneration

PURPOSE: To report the results of three methods of foveal translocation in the presence of subfoveal choroidal neovascular membrane resulting from age-related macular degeneration. METHODS: We treated 51 eyes of 51 consecutive patients with subfoveal choroidal neovascular membranes resulting from age-related macular degeneration with one of three techniques of foveal translocation surgery: foveal translocation with partial retinotomy (n = 6), limited translocation (n = 9), and translocation with 360-degree retinotomy (n = 36). All patients were followed for at least 6 months postoperatively. The size of the choroidal neovascular membrane and the amount of foveal displacement, the best-corrected visual acuity, and complications were recorded preoperatively and postoperatively. RESULTS: The mean distance of the foveal translocation was greater in the 360-degree retinotomy group (3340 microm) than in the partial retinotomy (1060 microm, P <.001) and the limited translocation groups (1120 microm, P <.001). A final visual acuity of 20/200 or better was achieved in two eyes (33%) in the partial retinotomy group, seven eyes (78%) in the limited translocation group, and 23 eyes (64%) in the 360-degree retinotomy group. The final visual acuity improved by 0.2 logarithm of minimal angle of resolution (logMAR) unit or more in one eye (17%), one eye (11%), and seven eyes (19%), respectively. The final visual acuity was maintained within 1 line in zero eyes, five eyes (56%), and 19 eyes (53%), respectively. A retinal detachment developed postoperatively in five eyes (83%), zero eyes (0%), and 15 eyes (42%), respectively. CONCLUSIONS: A significant number of patients improved or maintained best-corrected visual acuity after translocation with 360-degree retinotomy, and limited translocation, whereas translocation with 360-degree retinotomy is suitable for larger choroidal neovascular membranes because it resulted in the greatest foveal displacement among the three translocation procedures.     

One year follow up of macular translocation with 360 degree retinotomy in patients with age related macular degeneration

AIM: To evaluate the benefits of macular translocation with 360 degree retinotomy in patients with exudative age related macular degeneration (ARMD). METHODS: A consecutive interventional case series was performed on patients who underwent macular translocation between June 1997 and January 2000 at the department of ophthalmology, University of Aachen, Germany. A retrospective pilot study was set up with a minimum follow up of 12 months in 39 consecutive patients with subfoveal choroidal neovascularisation secondary to ARMD. The surgical technique included pars plana vitrectomy, induction of retinal detachment, 360 degree retinotomy, removal of the choroidal neovascular membranes (CNVM), macular translocation, peripheral laser retinopexy, and silicone oil endotamponade. RESULTS: 18 patients showed predominantly occult CNVM, six patients had predominantly classic CNVM, and 15 showed subretinal haemorrhage. At the 12 month follow up 13 patients (33%) showed an improvement in visual acuity of more than three lines (logMAR scale), 18 patients (46%) retained stable visual acuity with a change of equal or less than three lines (logMAR scale), and eight patients (21%) showed a decrease in visual acuity of more than three lines (logMAR scale). Recurrence of CNVM was observed in three (8%) eyes at 5-11 months postoperatively. Other complications included proliferative vitreoretinopathy with retinal detachment (n=10), peripheral epiretinal membranes (n=9), macular pucker (n=2), corneal decompensation (n=2), and hypotony (n=11). 18 patients (46%) complained about persistent diplopia. CONCLUSION: Macular translocation surgery is able to maintain or improve distant vision in the majority of patients with exudative ARMD. Proliferative vitreoretinopathy and diplopia are the two major complications. A prospective randomised controlled trial comparing macular translocation with observation for patients with the occult form of exudative ARMD may be justified.     

Morphologic and angiographic assessment of the macula after macular translocation surgery with 360 degrees retinotomy

PURPOSE: To compare the optical coherence tomographic assessment of retinal thickness and the fluorescein angiographic appearance after macular translocation surgery for subfoveal choroidal neovascularization. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Twenty-three consecutive eyes. INTERVENTION AND TESTING: Optical coherence tomography and fluorescein angiography were performed before and 6 to 15 months (mean +/- standard error [SE], 10.4+/-0.7) after macular translocation surgery with a 360 degrees retinotomy in 23 patients, ages 48 to 79 years, with age-related macular degeneration (12 eyes), polypoidal choroidal vasculopathy (2 eyes), and high myopia (9 eyes). The diameter of the choroidal neovascularizations ranged from 0.3 to 2.6 disc diameters (mean +/- SE, 1.2+/-0.2), and the angle of rotation of the retina ranged from 11 degrees to 45 degrees (mean +/- SE, 29.1+/-2.1 degrees ). RESULTS: The preoperative best-corrected visual acuity ranged from hand motions to 20/100, and the postoperative best-corrected visual acuity ranged from 20/667 to 20/25. Optical coherence tomography demonstrated a concave foveal configuration after surgery in all 23 eyes, with a mean foveal thickness of 150+/-11 micro m (mean +/- SE). Fluorescein angiography showed various degrees of fluorescein leakage with a pattern similar to cystoid macular edema in 16 of 23 eyes (70%). CONCLUSIONS: The newly located macula after macular translocation surgery with a 360 degrees retinotomy had cystoid macular edema on fluorescein angiography and normal macular configuration with normal thickness in optical coherence tomography.     

Change in full-field ERGs after macular translocation surgery with 360 degrees retinotomy

PURPOSE: One of the methods used in macular translocation (MT) surgery for subfoveal neovascularization is to create a temporary total retinal detachment followed by a 360 degrees retinotomy. The whole retina is then shifted from the original surface of the retinal pigment epithelium (RPE), resulting in an unusual retina and RPE complex. The purpose of this study was to assess retinal function after MT surgery. METHODS: Full-field electroretinograms (ERGs) were recorded before and 4 to 8 months (mean, 5.4 months) after MT surgery with a 360 degrees retinotomy in 15 consecutive patients with age-related macular degeneration (10 eyes), high myopia (4 eyes), and polypoidal choroidal vasculopathy (1 eye). Their ages ranged from 57 to 74 years. The angle of rotation of the retina ranged from 18 degrees to 45 degrees (mean +/- SE, 30 +/- 2 degrees). In addition to the recording of the standard rod and mixed rod-cone ERGs after 30 minutes of dark adaptation, the cone single flash and 30-Hz flicker ERGs were recorded immediately after a light-adapting background was turned on (LA(0)) and also after 10 minutes of light adaptation (LA(10)). RESULTS: The mean amplitude of the full-field ERGs was reduced after surgery by 44% for the rod response, by 24% for the mixed rod-cone b-wave, by 12% and 35% for the cone single-flash b-wave at LA(0) and 30-Hz flicker ERGs at LA(0), respectively. The mean implicit times were delayed by 8 msec for the rod response, by 2 msec for the mixed rod-cone oscillatory potential (OP1), by 4 msec for the cone single-flash b-wave at LA(0), and by 6 msec for the 30-Hz flicker at LA(0). CONCLUSIONS: These results demonstrated a functional alteration in both the rod and cone components of the ERGs for the entire retina after MT surgery.     

Retinal changes after macular translocation with 360-degree retinotomy in monkey eyes

PURPOSE: To determine the morphologic and functional changes of the fovea and retina of monkey eyes after macular translocation with 360-degree retinotomy. DESIGN: Experimental study. METHODS: The retinas of eight monkey eyes were surgically translocated with a 360-degree retinotomy with procedures similar to those used on human eyes. At 1, 2, and 3 months after the surgery, the six eyes that had successful surgery were studied by light and transmission electron microscopy, terminal deoxynucleotidyl transferase (TdT)-dNTP terminal nick-end labeling (TUNEL) assay, and immunohistochemistry with peanut agglutinin (PNA) lectin and glial fibrillary acidic protein (GFAP). Retinal physiology was assessed by scotopic and photopic electroretinograms (ERGs). RESULTS: The fovea was successfully translocated approximately 30 to 40 degrees superiorly in six eyes. The translocated macula and fovea had a normal layered architecture with no TUNEL-positive cells, minimal misalignment of the outer segments, and strong immunoreactivity to GFAP. The mean amplitudes of the scotopic and photopic b-waves were significantly reduced at 1 month after the surgery, and there was only a slight recovery at 3 months. No significant changes were observed in the mean implicit times after the surgery. CONCLUSION: These findings indicate that macular translocation surgery with 360-degree retinotomy results in minimal morphologic alterations but significant depression of electrophysiologic function.     

Macular translocation after photodynamic therapy: a case report

BACKGROUND: Photodynamic therapy (PDT) and surgical macular translocation are concurrent treatment options for exudative age-related macular degeneration (ARMD). PDT is currently favoured because of positive study results and the non-invasive technique. We report a case of macular translocation with 360 degrees retinotomy after unsuccessful previous PDT for treatment of ARMD. CASE REPORT: PDT with verteporfin was performed in the left eye of a 79-year-old patient with exudative ARMD and predominantly classic juxtafoveal choroidal neovascularisation (CNV). Because of continuing visual loss and deteriorating angiographic signs three months after PDT, a surgical macular translocation with 360 degrees retinotomy was performed successfully. During the surgery increased adhesion between the CNV and the retina was observed in contrast to patients without previous PDT. In a second step three months later, counter-rotation of the ocular globe was achieved by muscle surgery and the silicone oil was removed in the same session. The best spectacle corrected visual acuity improved from 0.1 before the surgery to 0.4 nine months thereafter (six Snellen lines). No CNV recurrence was observed. Patient satisfaction with the surgery outcome is high. CONCLUSIONS: Macular translocation may be considered in cases of continuing deterioration after a previous PDT for treatment of exudative ARMD. Possible complications must be discussed with the patient. Intraoperatively, increased adhesion of CNV to the retina was observed, which might increase the risk of inadvertent damage to the retina during surgery.     

Effective macular translocation without scleral imbrication.

PURPOSE: To describe a case of effective macular translocation accomplished without scleral imbrication or extensive retinotomy. METHODS: A case report of a 59-year-old woman with subfoveal choroidal neovascularization in her left eye who underwent vitrectomy with macular detachment and fluid-air exchange. RESULTS: The macula was translocated approximately 500 microm inferiorly, allowing for photocoagulation of extrafoveal neovascularization. CONCLUSION: Limited macular translocation may be attained without scleral imbrication or significant retinotomy.     

Iatrogenic choroidal neovascularization occurring in patients undergoing macular surgery

PURPOSE: To report three cases of choroidal neovascularization (CNV) that occurred following surgical disruption of Bruch membrane during macular surgery. METHODS: A retrospective case series was compiled. Macular translocation surgery with punctate retinotomy was performed in two patients for subfoveal CNV, and pars plana vitrectomy with epiretinal membrane (ERM) peeling was performed in one patient for idiopathic ERM. RESULTS: CNV developed at a site of subretinal cannulation in two cases of macular translocation, and at a site of inadvertent injury to Bruch membrane with a vitreoretinal pick in the one case that underwent ERM peeling. CONCLUSIONS: These cases underscore the need to monitor breaks in Bruch membrane for CNV following macular surgery.     

Translocation of the macula for retrofoveal choroidal neovascularization in age-related macular degeneration and severe myopia: first results

BACKGROUND: Subfoveal choroidal neovascularization is a main cause of blindness. The new surgical technique of macular translocation conceived by De Juan, with scleral shortening and without a retinotomy, allows to move the fovea away from the neovascular membrane with a low rate of complications. The first results obtained with this technique are presented here, in cases of submacular neovascularization due to age-related macular degeneration (AMD) or degenerative myopia. PATIENTS AND METHODS: The first 10 patients who were operated on with this technique presented with subfoveal neovascularization due to AMD (6 eyes) or myopia (4 eyes). The time period between the beginning of the disease and surgery was less than 3 months. Before and after surgery, a complete examination included fluorescein and ICG angiographies and OCT. RESULTS: Visual acuity improved by 2 lines or more in 6 eyes (60%), was unchanged in 3 eyes (30%) and decreased in 1 eye. The improvement in vision seemed higher in myopia than in ARMD. Conversely, the mean foveal displacement was greater in ARMD than in myopia (1.2 disc diameter and 0.5 respectively). Laser photocoagulation has been performed in all patients after surgery. Main complications were retinal detachment (1 eye) and neovascularization at the site of transretinal injection (1 eye). Mean follow-up was 3 months. COMMENTS: Macular translocation with the technique described by De Juan allowed visual improvement in more than the half of the eyes with subfoveal neovascularization, resulting in a moderate rate of complications. Long term follow-up is necessary to confirm these results.     

Postoperative abnormalities of the choriocapillaris in exudative age-related macular degeneration.

AIMS: To study the incidence and possible cause of abnormalities of the subfoveal choriocapillaris after surgical excision of subfoveal choroidal neovascularisation in age-related macular degeneration (ARMD). METHODS: The postoperative fluorescein angiograms and colour photographs of 29 eyes of 29 patients were reviewed after surgical excision of subfoveal choroidal neovascularisation in exudative ARMD. Preoperative and postoperative fluorescein angiograms were examined for perfusion of the subfoveal choriocapillaris. The excised subfoveal choroidal neovascular membranes from eight eyes that demonstrated postoperative abnormalities of the choriocapillaris were embedded in paraffin, serially sectioned and examined for the presence of the choriocapillaris. RESULTS: Postoperative fluorescein angiograms revealed abnormal perfusion of the subfoveal choriocapillaris in 26 of the 29 eyes (90%) and in all eight eyes that had histopathological examination of the surgical specimens. Examination of serial sections demonstrated that none of the excised neovascular membranes contained choriocapillaris. CONCLUSIONS: Abnormal perfusion of the subfoveal choriocapillaris was frequently present following removal of the subfoveal neovascular membrane in ARMD. The histopathological study demonstrated that abnormalities of the choriocapillaris were not due to removal of the choriocapillaris at the time of surgery.     

Macular translocation for surgical management of subfoveal choroidal neovascularizations in patients with AMD: first results

Background: At present no satisfying treatment for subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) is available. Visual results after successful surgical removal of subfoveal CNV are disappointing. This has been explained by a primary dysfunction of the retinal pigment epithelium (RPE) in the macular region and the surgical trauma to the RPE in patients with AMD. Therefore, Machemer and Steinhorst developed a technique for macular translocation after surgical removal of subfoveal CNV. We report our first experiences with this technique in patients with subfoveal CNV secondary to AMD. · Methods: Seven patients aged between 71 and 83 years with subfoveal CNV were included in the study. Visual acuity of the fellow eyes was below 20/400. All patients underwent pars plana vitrectomy. Retinal detachment was produced by subretinal infusion of balanced salt solution and a 360° retinotomy at the base of the vitreous was performed. After removal of the CNV, retinal rotation and reattachment, the retina bordering the retinotomy was coagulated with endolaser photocoagulation. Silicone oil was used as temporary tamponade. · Results: In all patients the subfoveal CNV was removed and the macula was translocated by a 15°–45° rotation onto functional RPE. The mean duration of follow-up was 11±3 months. Initial visual acuity ranged from 20/80 to hand movements. Final visual acuity was 20/100 to 20/400. Initially all patients complained of tilted vision. During follow-up the rotation of the image regressed and was well tolerated by all patients. Complications included the development of retinal detachment in three patients after silicone oil removal, development of a macula pucker, and a significant increase of lens opacity in the phakic eyes. · Conclusion: In our series rapid improvement of visual function was observed in one patient only, even if the macula appeared ophthalmoscopically and angiographically normal. Vitreoretinal complications occurred frequently during follow-up. Received: 2 February 1998 Revised version received: 6 April 1998 Accepted: 29 April 1998     

Visual function 5 years or more after macular translocation surgery for myopic choroidal neovascularisation and age-related macular degeneration

Purpose

To evaluate the changes in the best-corrected visual acuity (BCVA) after 1 year and after ≥5 years after macular translocation for age-related macular degeneration (AMD) or myopic choroidal neovascularisation (mCNV).

Methods

The medical records of 61 consecutive patients who underwent macular translocation with 360° retinotomy for AMD (35 eyes) or mCNV (26 eyes) were reviewed. Overall, 40 patients, 17 mCNV and 23 AMD, were followed for at least 5 years. BCVA and area of the Goldmann visual field (VF) measured before, 12 months after surgery, and at the final visit.

Results

In the 23 AMD eyes followed for ≥5 years, the mean preoperative BCVA was 1.149±0.105 logMAR units, which significantly improved to 0.69±0.06 logMAR units at 1 year (P<0.001). This BCVA was maintained at 0.633±0.083 logMAR units on their final examination. In the 17 eyes with mCNV followed for ≥5 years, the mean preoperative BCVA was 1.083±0.119 logMAR units, which was significantly improved to 0.689±0.121 logMAR units at 1 year (P=0.001). This BCVA was maintained at 0.678±0.142 logMAR units on their final examination. The area of the VF was significantly decreased at 12 months and did not change significantly thereafter.

Conclusions

Our results show that macular translocation surgery significantly improves the BCVA and significantly decreases the VF area of eyes with mCNV or AMD after first 1 year. The BCVA and VF area do not change significantly from the values at 1 year for at least 5 years.     

Severe hypotony after macular translocation surgery with 360-degree retinotomy

PURPOSE: To report a case of severe hypotony after macular translocation with 360-degree retinotomy. DESIGN: Interventional case report. METHODS: A 50-year-old woman with myopic neovascular maculopathy underwent macular translocation with 360-degree retinotomy in her left eye. RESULTS: After the second procedure of silicone oil removal, severe hypotony developed. No clear sign of leakage was found. Pure perfluoropropane gas tamponade was then performed, which resulted in temporal resolution of severe hypotony, but the hypotony recurred as the gas bubble was absorbed. Ten weeks after the second surgery, the hypotonous eye was refilled with silicone oil. No apparent cyclitic membrane was observed intraoperatively. After this procedure, the choroidal and retinal folds regressed; intraocular pressure has been between 5 and 7 mm Hg for more than 4 months thereafter. CONCLUSION: Severe hypotony can occur as a complication of otherwise uneventful macular translocation with 360-degree retinotomy.     

Limited macular translocation for subfoveal choroidal neovascularization in age-related macular degeneration

Purpose: To examine the safety and efficacy of limited macular translocation followed by laser photocoagulation in the management of subfoveal choroidal neovascularization (CNV) in age‐related macular degeneration (AMD). Methods: A prospective study was conducted on eight consecutive patients undergoing limited macular translocation followed by laser photocoagulation for the treatment of subfoveal classic CNV form of AMD. Patients were followed up for a minimum of 12 months. The magnitude of foveal translocation, visual outcomes and complications were assessed. Results: In all cases the fovea was successfully translocated inferiorly, with a median displacement of 1.1 mm. Thermal laser photocoagulation was subsequently performed in all cases. Visual acuity improved in five eyes, remained unchanged in two eyes and worsened in one eye. The mean improvement in visual acuity was by 0.19 logMAR. At 12 months, six of the eight patients (75%) achieved Snellen visual acuity of at least 6/15, with four patients (50%) achieving Snellen visual acuity of 6/9. Conclusion: In this small case series, limited macular translocation was found to be an effective and reproducible means of treating small well‐defined subfoveal CNV.