Abstract
Purpose: :
One–year follow–up of macular translocation surgery with 360° retinotomy in patients with subfoveal CNV secondary to AMD showed stabilization or improvement of visual acuity in 61 of 90 patients. Here we present the result of the long–term follow–up of these patients.
Methods: :
Between 1997 and 1999, 90 eyes from 90 consecutive patients with recent visual loss due to subfoveal CNV resulting from AMD underwent macular translocation surgery with 360° retinotomy. Twenty six patients had major macular subretinal hemorrhage, 39 patients had occult and 25 patients classic subfoveal choroidal neovascularization. The patients underwent anterior segment and fundus examination, ETDRS visual acuity and angiography.
Results: :
Mean follow–up was 38 months (4–79 months± 22). At the end of the observation period (May 2005) 25 patients (27.8%) had died, 65 patients were alive (72.2%). Preoperatively visual acuity (VA) ranged from hand movement to 20/50 with a median of 20/200. 24 months postsurgically VA ranged from intact light projection to 20/40 with a median of 20/400. Final visual acuity ranged from no light perception to 20/40 with a median of 1,2. An increase in VA of 15 or more ETDRS letters was observed in 24 patients at one year, in 18 patients at two years and in15 patients at their final examination. VA was stable in 37 patients at one year, in 29 patients at two years and in 34 patients at their final examination. Deterioration of VA by 15 or more EDTRS chart letters was observed in 29 patients at 12 months, in 43 patients at 24 months and in 41 patients at the final examination. At the final follow–up examination RPE and choroidal atrophy extending to the new fovea was observed in 44 patients (48.9%), whereas in 28 patients the fovea appeared clinically healthy. For 18 patients this information was not available. In 25 patients (56.8%) foveal atrophy was associated with a loss of 15 or more lines and macular edema was observed in 6 patients (6,7%). After one year postsurgically 22 patients experienced retinal complications (24,4%), 20 of which necessitated revisional surgery.
Conclusions: :
Macular translocation surgery results in encouraging functional visual results after 12 months. Long term follow–up showed stabilization or improvement in approximately 50% of the patients while in 50% of the patients visual acuity deteriorated. Secondary geographic atrophy was a statistically significant factor leading to deterioration of visual acuity.
Keywords: age-related macular degeneration • macula/fovea • choroid: neovascularization