97th DOG Annual Meeting 1999
MACULAR TRANSLOCATION AS A TREATMENT MODALITY FOR EXSUDATIVE AGE-RELATED MACULAR DEGENERATION
S. Aisenbrey, K. U. Bartz-Schmidt, B. Lafaut, P. Walter, P. Szurman,
Background: Achieving stabilisation or even improvement of visual acuity is the purpose of translocating the fovea to healthier appearing retinal pigment epithelium (RPE) in exsudative age-related macular degeneration (AMD). The procedure consists in a combination of counterrotation of the globe, phakoemulsification and implantation of a posterior chamber lens, complete vitrectomy, total iatrogenic retinal detachment, 360º anterior retinotomy, removal of the neovascular complex, foveal translocation outside the RPE defect, reattachment of the retina using carbon liquid, peripheral laser retinopexy and temporary silicone oil tamponade.
Patients: We operated in 34 patients (25 women and 9 men, median age = 76 (range 61-86) years) between December 1997 and February 1999. All patients experienced visual loss of recent onset due to exsudative AMD: Ten patients had a major subretinal hemorrhage, which did not respond to pars plana gas and rtPA injection, 7 patients had occult and 17 patients classic subfoveal choroidal neovascularization. Prospectively all patients were examined 6 weeks, 3, 6 and 12 months after primary procedure including ETDRS visual acuity measurement, conventional fluorescein and indocyanine green angiography and microperimetry.
Results: At the end of February 1999 already in 14 patients silicone oil removal has been performed (interval to primary procedure mean = 15 weeks, range 7-37 weeks). In 6 of 10 patients without complications following silicone oil removal visual acuity increased between 1 and 12 lines (median 4 lines). In 4 patients a secondary procedure became neccessary due to severe complications following silicone oil removal (PVR redetachement n = 1, rhegmatogenous retinal redetachement n = 2, macular pucker n = 1). 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 requiring a long learning curve with a high rate of surgical and postoperative complications. The initial results of foveal translocations seem to be promising for selected patients with exsudative AMD.
Universitäts-Augenklinik Köln, Joseph-Stelzmann-Str. 9, D-50931 Köln