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C.I. Falkner, S. Binder, H. Leitich, F. Frommlet, P. Bauer; Removal of Subfoveal Choroidal Neovascularization versus Macular Translocation for Age–Related Macular Degeneration: A Meta–Analysis . Invest. Ophthalmol. Vis. Sci. 2005;46(13):197.
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Purpose: Submacular surgery for age–related macular degeneration (AMD) is still controversial. A meta–analysis was carried out to evaluate the results of the two most established submacular surgical techniques, namely removal of subfoveal choroidal neovascularization (CNV) and macular translocation. Methods: A Medline search for the years 1992 to 2004 was conducted. Original English– or German–language studies reporting the results of removal of subfoveal CNV or macular translocation for AMD were included. The quality of the studies included was scored using the Oxford Centre for Evidence–based Medicine Levels of Evidence (May 2001). The main outcomes were proportion of patients with 2 or more lines of improvement in visual acuity (VA) and proportion with 2 or more lines of deterioration in VA after surgery. A random effects logistic regression model was used to estimate combined outcome rates across studies and 95% confidence intervals. Results: Sixty three studies met the inclusion criteria. Treatment specific estimates gave comparable results for removal of CNV (31 studies, 771 cases; improvement of VA 28%, deterioration of VA 25%) and for macular translocation (32 studies, 792 cases; improvement of VA 31%, deterioration of VA 27%). The complication rate for removal of CNV was lower (50% versus 71%) and the recurrence rate was slightly higher (22% versus 16%) compared to macular translocation. Three of the studies included were level 1 randomized clinical trials and showed considerably lower rates of improvement of VA (14%, 8.8% and 10%) and also considerably higher percentages of deterioration (50%, 37.5% and 36.7%). Neither the other tested variables, such as year of study publication, minimum and maximum follow–up time or the number of cases nor subgroup analysis regarding the duration of follow–up and the number of cases as well as a cross–tabulation of type of study by size of study and follow–up of study showed any significant influence on the outcome. Conclusions: The results of submacular surgery should be considered in view of the natural course of AMD and other current treatment options, such as photodynamic therapy and laser photocoagulation. Submacular surgery has the additional benefit of not being limited by size, type or location of CNV.
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