Case selection in macular relocation surgery for age related macular degeneration

Abstract

Background: To date there has been no randomised controlled trial demonstrating the safety and efficacy of macular relocation surgery (MRS) for age related macular degeneration (AMD). Vision can be improved in some patients and made worse in others despite successful surgery or because of complications. Purpose: To determine which patients would benefit from MRS. Methods: Twenty nine patients with exudative AMD took part in a prospective, non-comparative, interventional study. Macular relocation surgery involved phacoemulsification, vitrectomy, 360˚retinotomy, excision of choroidal neovascular membrane, and macular relocation using an infusion of 5-fluorouracil and low molecular weight heparin as adjuvant to prevent proliferative vitreoretinopathy. Patients underwent protocol refraction preoperatively and six-monthly postoperatively by designated optometrists. Preoperative fundus fluorescein angiograms were read by masked observers and the lesions were classified according to a set protocol. The main outcome measures were visual improvement, final vision of better than 20/400, reading speed, critical print size. Logistic and multiple stepwise linear regressions were used to identify independent factors which predicted the main outcomes. Results: Preoperative visual acuity (20/120 or worse) and lesion type (predominantly classic or submacular haemorrhage) were significantly associated with visual improvement (coefficient of regression B = 26.8, p,0.001 and B = 14.9 with p = 0.045 respectively). There were no significant independent factors which predicted a final distance logMAR visual acuity of 1.3 (20/400) or any arbitrary definition of blindness. Conclusions: The study showed that it was possible to select cases that were more likely to experience an improvement in vision following MRS.

Long-term Follow-up of Macular Translocation With 360° Retinotomy for Exudative Age-Related Macular Degeneration

“…In our series, the preoperative level of VA did not prove to be a statistically significant factor for change in VA postoperatively. Similar findings have been reported by Wong et al 19 Lesion size and lesion composition also have been proposed to impact visual outcome. At 12 months, we saw better outcome in patients with hemorrhagic AMD or classic CNV, whereas Wong et al 19 reported poorer functional outcome for patients with minimally classic CNV compared with patients with predominantly classic CNV.…”

“…Thus, case selection may be the key to predict outcome and to define the role of full macular translocation. 19 However, data on predictive factors are inconsistent. Mruthyunjaya and coworkers 15 reported that better levels of preoperative visual function were predictive of better levels 12 months after full macular translocation.…”

Autologous translocation of the choroid and RPE in age-related macular degeneration: 1-year follow-up in 30 patients and recommendations for patient selection

“…Wong et al 29 have demonstrated for full macular translocation, that preoperative VA (20/120 or better) and lesion type (predominantly classic or submacular haemorrhage) is predictive for visual improvement. This is in accordance to our results indicating that patients benefit the most when the duration of the disease is shortest (probably in patients with classic or predominantly classic lesions and submacular haemorrhage).…”

Full macular translocation following photodynamic therapy in neovascular age-related macular degeneration

“…[7][8][9] Complication related to FMT included retinal detachment, macular oedema, persistent hypotony, and disturbing diplopia. [7][8][9] Our results showed a slightly more favourable visual outcome for patients receiving more than one PDT session before the FMT, differing from the results of Park and Toth. 5 However, the small sample size analysed in both studies makes a reasonable statement difficult.…”

“…[3][4][5][6][7][8][9] The purpose of this retrospective case study is to elucidate the long-term functional and morphological outcome of PDT-nonresponders who had undergone FMT in neovascular AMD.…”