Surgical Treatment of Tears of the Retinal Pigment Epithelium Secondary to Age–Related Macular Degeneration

Abstract

Abstract: : Purpose: To report the functional and morphological results of surgical treatment of tears of the retinal pigment epithelium (RPE) secondary to neovascular age–related macular degeneration (AMD). Methods: This retrospective study included all consecutive patients between May 2001 and June 2004, who underwent macular translocation with 360 degree retinotomy (MT–360) or extraction of the CNV for tear of the RPE in AMD. All patients had a follow–up of at least 6 months. Visual acuity examination, fluorescein angiography and fundus photography were obtained preoperatively and at regular intervals postoperatively. Visual acuity Snellen and ETDRS equivalents were converted into logMAR units for statistical purposes. Results: Thirteen eyes of 13 patients (9 women and 4 men, ranging in age 66–89 years) were analysed that fulfilled the inclusion criteria. The median follow–up was 12 months (range 6 – 32 months). Nine patients underwent MT–360 (6 women and 3 men, range in age 73–89 years) and four patients (3 women and 1 man, range in age 66–83 years) underwent surgical extraction of the CNV. Mean visual acuity at baseline and at the last follow up examination was 10/200 (range 10/63 to hand movement) and 10/160 (range 10/32 to hand movement), respectively. In the MT–360 group, visual acuity improved by at least 2 ETDRS lines in five of nine patients (2 to 5 lines). The visual acuity was unchanged in three cases and worsened by 3 ETDRS lines in one case. In the CNV–extraction group, the visual acuity remained stable at baseline in 3 of 4 eyes (+/– 1 line) and decreased by 2 ETDRS lines in 1 eye. Mean visual acuity in the MT–360 group improved by 2 ETDRS lines. Mean visual acuity in the CNV–extraction group was unchanged. Two eyes in the MT–360 group had proliferative vitreoretinopathy associated with retinal detachment, which required further surgery. Three patients of the MT–360 group had intermittent diplopia under binocular conditions after counter rotation of the globe, which required repeat strabismus surgery in one patient. Conclusions: In the presented retrospective case series, the visual acuity could be stabilized or improved in majority of the eyes in MT–360 group with tear of the RPE secondary to AMD. CNV extraction in such eyes was associated with a stabilisation of the visual acuity.

Keywords: retinal pigment epithelium • vitreoretinal surgery • age-related macular degeneration