Recurrence of Choroidal Neovascularization and Geographic Atrophy After Macular Translocation Surgery With 360–Degree Peripheral Retinectomy

Abstract

Abstract: : Purpose: To evaluate the recurrence of choroidal neovascularization (CNV) and geographic atrophy (GA) in patients undergoing macular translocation surgery with 360 degree peripheral retinectomy (MT360) for age–related macular degeneration (AMD). Methods: Sixty–four eyes of 64 patients had MT360 for neovascular AMD as part of the Duke Macular Translocation Study with 2 year follow–up data. Four eyes of 4 patients with GA had MT360 with mean follow–up of 19.3 months. In a retrospective review of these MT360 patients, clinical data and fluorescein angiograms were reviewed for recurrence of CNV and GA. Results: CNV recurred in 14 of 64 (22%) eyes. Twelve of the 14 recurrences (86%) occurred at the site of the old CNV bed. Two of the 14 (14%) developed subfoveal CNV with questionable connection to the previous CNV bed. When recurrent CNV occurred at the old CNV bed, 11 of the 12 (92%) involved the border of the bed closest to the repositioned fovea, and 8 of the 12 (67%) would eventually extend subfoveally despite treatment. None of the four patients undergoing MT360 for GA developed CNV afterward, and three (75%) of the patients developed recurrent GA in the fovea. No patient undergoing MT360 for CNV developed GA postoperatively. Conclusions: After MT360, CNV occurred only in those patients who initially presented with neovascular AMD, and recurrent GA occurred only in those patients who initially presented with nonneovascular AMD. Over 75% of patients do not have recurrence of CNV after MT360 for neovascular AMD, and almost every CNV recurrence after MT360 developed in the bed of the previous CNV. Close follow–up after MT360 is warranted to assess for recurrence of CNV so that it can be treated before it extends subfoveally. Recurrent CNV involving the old bed almost always involved the area closest to the fovea suggesting a signaling mechanism from the fovea.

Keywords: age-related macular degeneration • macula/fovea • vitreoretinal surgery