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

Background: At present no satisfying treatment for subfoveal choroidal neov ascularization (CNV) secondary to age-related macular degeneration (AMD) is available. Visual results after successful surgical removal of subfoveal C NV are disappointing. This has been explained by a primary dysfunction of t he 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 s ubfoveal CNV. We report our first experiences with this technique in patien ts with subfoveal CNV secondary to AMD. Methods: Seven patients aged betwee n 71 and 83 years with subfoveal CNV were included in the study. Visual acu ity of the fellow eyes was below 20/400. All patients underwent pars plana vitrectomy. Retinal detachment was produced by subretinal infusion of balan ced salt solution and a 360 degrees 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 photocoa gulation. Silicone oil was used as temporary tamponade. Results: In all pat ients the subfoveal CNV was removed and the macula was translocated by a 15 degrees-45 degrees rotation onto functional RPE. The mean duration of foll ow-up was 11+/-3 months. Initial visual acuity ranged from 20/80 to hand mo vements. Final Visual acuity was 20/100 to 20/400. Initially all patients c omplained of tilted vision. During follow-up the rotation of the image regr essed and was well tolerated by all patients. Complications included the de velopment of retinal detachment in three patients after silicone oil remova l, development of a macula pucker, and a significant increase of lens opaci ty in the phakic eyes. Conclusion: In our series rapid improvement of visua l function was observed in one patient only, even if the macula appeared op hthalmoscopically and angiographically normal. Vitreoretinal complications occurred frequently during follow-up.