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T. Stappler, D. Wong; Does It Work? A Longitudinal and Comparative Study of Eyes With Exsudative AMD Treated With 360° Macular Translocation Using the Fellow Eye as Control . Invest. Ophthalmol. Vis. Sci. 2005;46(13):3628.
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Purpose:The use of 360 retinotomy and macular rotation for the treatment of AMD remains controversial. Visual improvement does not occur in every anatomically successful case; surgical complications can also lead to loss of vision. Methods: We report on a prospective consecutive and longitudinal study and compare the visual outcome of the treated eye with that of its fellow. We present our orthoptic outcomes as well as quality of life data. Results: 61 patients from a consecutive series operated upon over a 3 year period were studied. The mean preoperative visual acuity (VA) was 20/230 for the operated eye and 20/300 for the fellow eye; the final VA was 20/190 and 20/300 respectively. Preoperatively, we found predominantly classic membranes in 27 cases, minimally classic membranes in 26 and submacular haemorrhages in 8 cases. The mean lesion size was 5.3 mm GLD. Compared to its fellow, the operated eye had significantly greater chance of any visual improvement: improvement by 1 line; 2 lines and 3 lines (p=0.02; p=0.02; p=0.007; p=0.03); had no significantly greater chance of any visual deterioration: deterioration by 1 line; 2 lines or 3 lines (p=0.89; p=0.07; p=0.51; p=0.06); had significantly less chance of having vision of 20/500 or worse (p=0.001) and better chance of 20/200 or better (p=0.001). The incidence of VA being 20/800 or worse is the same. Comparing postoperative to preoperative vision, we found that submacular haemorrhages and predominantly classic membranes show significantly greater improvement than minimally classic membranes. Orthoptically, we achieved binocular simultaneous vision in 24%, exclusion of the fellow eye in 35%, exclusion of the operated eye in 30% and diplopia in 10% of cases. The gain in vision has been maintained for two years. Sight threatening complications such as retinal detachment occurred in 8 (12.7%) of 63 cases. The quality of life data show a significant improvement for near vision tasks. Conclusions: The proof of principle is established that surgery can improve vision in some patients. In the absence of published randomised trials, clear and simple results from longitudinal studies may help to inform patients and clinicians in deciding on this treatment.
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