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Macular Translocation With 360° Retinotomy for Exudative Age-Related Macular Degeneration
Sabine Aisenbrey, MD;
Bart A. Lafaut, MD;
Peter Szurman, MD;
Salvatore Grisanti, MD;
Christoph Lüke, MD;
Ralf Krott, MD;
Gabriele Thumann, MD;
Julia Fricke, MD;
Antje Neugebauer, MD;
Ralf-Dieter Hilgers, PhD;
Peter Esser, MD;
Peter Walter, MD;
Karl Ulrich Bartz-Schmidt, MD
Arch Ophthalmol. 2002;120:451-459.
Background Macular rotation surgery comprises surgical extraction of choroidal
neovascular membranes in age-related macular degeneration (AMD) and translocation
of the foveal neural retina over adjacent retinal pigment epithelium.
Objective To determine whether macular translocation with 360° retinotomy
can stabilize and/or improve visual acuity in patients with subfoveal choroidal
neovascularization (CNV) secondary to AMD.
Design This study consisted of a standardized surgical procedure on a series
of 90 consecutive patients and follow-up examinations at fixed intervals for
12 months.
Participants All patients in this study had experienced recent visual loss resulting
from subfoveal CNV caused by AMD. Twenty-six patients had major macular subretinal
hemorrhage, 39 patients had occult subfoveal CNV, and 25 patients had classic
subfoveal CNV.
Methods Macular translocation surgery was performed between 1997 and 1999. The
patients were examined preoperatively and at 3, 6, and 12 months postoperatively,
including visual acuity, microperimetry, angiography, and orthoptic assessment.
Results Visual acuity increased by 15 or more letters in 24 patients, remained
stable in 37 patients, and deteriorated by 15 or more letters in 29 patients
at 12 months postoperatively. A secondary procedure was necessary in 17 patients
because of severe complications; proliferative vitreoretinopathy was observed
in 17 eyes, macular pucker in 5 eyes, and macular hole in 1 patient.
Conclusion Macular translocation is a technically demanding surgical procedure.
Although the procedure has a high rate of surgical and postoperative complications,
the functional and anatomical results appear to be promising for selected
patients with subfoveal CNV secondary to AMD.
From the Departments of Vitreoretinal Surgery (Drs Aisenbrey, Lafaut,
Szurman, Grisanti, Lüke, Krott, Thumann, Esser, Walter, and Bartz-Schmidt)
and Strabismus Therapy and Neuroophthalmology (Drs Fricke and Neugebauer),
University of Cologne, Cologne, Germany; Department of Ophthalmology, Ghent
University Hospital, Ghent, Belgium (Dr Lafaut); Department of Medical Biometry,
Rheinisch Westfälische Technische Hochschule, Aachen, Germany (Dr Hilgers);
and Department I, University Eye Clinic Tuebingen, Tuebingen, Germany (Drs
Szurman, Grisanti, and Bartz-Schmidt).
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