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Visual Outcomes Following Macular Translocation With 360° Peripheral Retinectomy
James C. Lai, MD;
Deborah J. Lapolice, MS;
Sandra S. Stinnett, DrPH;
Carsten H. Meyer, MD;
Luz M. Arieu, MD;
Melissa A. Keller;
Cynthia A. Toth, MD
Arch Ophthalmol. 2002;120:1317-1324.
Objective To evaluate visual outcomes following macular translocation with 360°
peripheral retinectomy in patients with subfoveal choroidal neovascularization
secondary to age-related macular degeneration.
Methods In a prospective study, 15 consecutive patients with large subfoveal
choroidal neovascularization underwent macular translocation with 360°
peripheral retinectomy and silicone oil tamponade. Preoperative and postoperative
photographs and fluorescein angiograms were obtained to evaluate lesion size
and characteristics and translocation results. Standardized near and distance
visual acuity and reading speed were measured preoperatively and 6 and 12
months postoperatively.
Main Outcome Measures Changes in and final levels of near and distance visual acuity and reading
speed.
Results Median lesion size was 9 Macular Photocoagulation Study disc areas (range,
4-16 disc areas). In all patients, the fovea was successfully translocated
off the subfoveal lesion. The median near visual acuity logMAR score (logarithm
of the minimum angle of resolution) improved significantly from 0.54 units
to 0.40 units (Snellen equivalent, 20/70 to 20/50; P =
.02) at the 6-month follow-up and stabilized at 0.54 (12 months postoperatively;
Snellen equivalent, 20/70). Seven (54%) of 13 patients and 7 (58%) of 12 patients
achieved reading speeds of 70 words/min or greater at the 6-month and 12-month
postoperative visits, respectively. Median preoperative distance visual acuity
(20/100) was maintained at both the 6-month and 12-month examinations. No
postoperative retinal detachments occurred in this series.
Conclusion Macular translocation with 360° peripheral retinectomy and silicone
oil tamponade stabilizes and can sometimes improve near and distance visual
acuity and reading speed in patients with vision loss from subfoveal neovascular
age-related macular degeneration.
From the Department of Ophthalmology, Vitreoretinal Service, Duke University
Medical Center, Durham, NC. Dr Toth and the Duke University Eye Center Biophysics
Laboratory developed the 36-gauge retinal needle and the Roundball cannula
described in this article and receive research support and royalties from
Alcon Laboratories (Fort Worth, Tex). The authors have no financial interest
in other products mentioned in this article.
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