Macular Translocation Helpful in Age-Related Macular Degeneration

Laurie Barclay, MD

October 31, 2003

Oct. 31, 2003 — Patients with end-stage age-related macular degeneration (AMD) benefit from macular translocation surgery with 360° peripheral retinectomy (MT360) even after undergoing ocular photodynamic therapy (OPT), according to the results of a retrospective review published in the November issue of the American Journal of Ophthalmology.

"Until now MT360 had been used in patients with recent central vision loss from AMD in their newly affected second eye, but it hadn't been evaluated in patients who had undergone previous macular treatment. We now have shown that this may be an option for patients who are experiencing continued vision loss despite previous treatments for AMD," senior author Cynthia A. Toth, MD, from Duke University Medical Center in Durham, North Carolina, says in a news release. "This technique often allows us to recover a patient's reading vision. It isn't a cure, but our patients' feedback has been very exciting."

This observational case series involved review of eight eyes of eight patients with subfoveal choroidal neovascularization associated with AMD who underwent MT360 with silicone oil tamponade from Aug. 5, 1998, through Dec. 1, 2002. All patients had at least one treatment of OPT with verteporfin (mean, 1.5 treatments) but had continued visual loss before surgery. Mean preoperative visual acuity was 56 letters, and preoperative optical coherence tomography revealed cystoid macular edema in four of the eight eyes.

Except for a retinal detachment in one eye that was successfully repaired, there were no significant postoperative complications. Mean visual acuity was 54 letters at three months and 61 letters at last follow-up (mean, 10 months; P = .50).

In five eyes that had only one prior OPT, the final mean visual acuity change was +10 letters, compared with –1 letter in three eyes that had multiple OPT sessions. Last follow-up revealed ongoing cystoid macular edema in three of the four eyes that had it before surgery. In two eyes that had concurrent cataract extraction surgery with MT360, cystoid macular edema did not develop. No eyes developed recurrent choroidal neovascularization after surgery.

Potential complications cited by Dr. Toth include bleeding, retinal detachment risk of about 10%, diplopia, and residual tilting, which usually responds to special glasses or additional muscle surgery.

"While not everyone is a candidate, we now have more options," Dr. Toth says. "I once had to tell patients, if they had bad scarring in their eyes and we had already tried conventional therapies, that we were out of options. It's rather rewarding to be able to help someone who can now see pictures of their grandchildren or who can read again."

The authors recommend a randomized clinical trial comparing MT360 versus OPT for the treatment of classic subfoveal choroidal neovascularization. The Duke University Eye Center NIH Core Grant and Euan and Angelica Baird helped support this study.

Am J Ophthalmol. 2003;136(5): 830-835

Reviewed by Gary D. Vogin, MD