Macular translocation with 360° Retinotomie in the management of AMD
S. Aisenbrey, B. Lafaut, P. Walter, P. Szurman, K. U. Bartz-Schmidt
Background: Achieving stabilization or even improvement of visual acuity is the purpose of translocating the fovea to healthier appearing retinal pigment epithelium (RPE) in exudative age-related macular degeneration (AMD).
Methods: The procedure combines counterrotation of the globe, phakoemulsification and implantation of a posterior chamber lens, complete vitrectomy, induction of a total retinal detachment, 360° anterior retinotomy, removal of the neovascular complex, foveal translocation outside the RPE defect, reattachment of the retina using F6H8, peripheral laser retinopexy and temporary silicone oil tamponade.
Patients: We operated in 100 patients (64 women and 36 men, mean age = 75 ± 6 years) between December 1997 and October 1999. All patients experienced visual loss of recent onset due to exudative AMD: Twenty-two patients had a major subretinal hemorrhage, which did not respond to pars plana gas and rtPA injection, 36 patients had occult and 31 patients classic subfoveal choroidal neovascularization. Pigment epithelial detachment (n=2), tear of the pigment epithelium (n=4), polypoidal choroidal vasculopathy (n=1), recurrent CNV following laser/radiation therapy (n=3) and disciform lesion (n=1) were preoperative findings in the remaining 11 patients. All patients were examined prospectively preoperatively, at 6 weeks, 3, 6 and 12 months after primary procedure including ETDRS visual acuity measurement, SLO microperimetry, fluorescein and indocyanine green angiography.
Results: Intermediate term results at the end of November 1999 showed that silicone oil removal was performed in 49 patients (interval to primary procedure: mean = 15 weeks, range 7-37 weeks). Visual acuity increased 15 or more ETDRS chart letters in 16 of 44 patients without silicone oil at last exam, in 7 of these 44 patients the visual acuity deteriorated 15 or more EDTRS chart letters. In 13 patients a secondary procedure was neccessary due to severe complications (rhegmatogenous retinal redetachment (n = 8), PVR detachment and macular pucker (n = 3), recurrent CNV (n = 2)). Other postoperative complications were transient hypotony, macular edema, IOL dislocation and keratopathy. No general medical complications were observed. Updated results will be presented at the meeting.
Conclusion: Macular relocation represents a technically difficult operation and requires a long learning curve with a high rate of surgical and postoperative complications. The initial results of foveal translocations seem however to be promising for selected patients with exudative AMD.
Zentrum für Augenheilkunde der Universität Köln, D-50935 Köln