Two–year Results of Limited Macular Translocation with Diagonal Chorioscleral Outfolding: Factors in Postoperative Visual Impairment

Abstract

Abstract: : Purpose: To evaluate the results of limited macular translocation with diagonal chorioscleral outfolding in patients with subfoveal choroidal neovascularization (CNV), and to identify factors involved in deteriorating postoperative visual acuity. Methods: Twenty–seven consecutive patients with surgically treated subfoveal CNV (age–related macular degeneration, n=17; myopic, n=7; idiopathic, n=3) were followed for more than 2 years. Limited macular translocation was performed using titanium clips to outfold the sclera and choroid diagonally for scleral shortening. Surgical outcomes including visual acuity, foveal displacement, surgically induced astigmatism, and complications were recorded. Factors contributing to the impairment of visual acuity during postoperative follow–up were identified by multiple logistic regression analysis. Results: Foveal displacement ranged from 349 to 3391 um (median 1576). Surgically induced astigmatism ranged from 0 to 3.0 (median 0.5) diopters. While visual acuity improved once in 19 of the 27 patients (70.4%, median 5 lines), in 14, final vision ultimately decreased from the best postoperative level. Final visual acuity improved from the preoperative base line in 11 patients (40.7%), remained unchanged in 7 (25.9%), and decreased in 9 (33.3%, median 6 lines). In our series, the mean of preoperative vision was 20/174, best postoperative was 20/74, and final vision was 20/167. Factors affecting postoperative visual impairment included the postoperative CNV status. Conclusions: Limited macular translocation with diagonal chorioscleral outfolding improved or stabilized the vision of 18 of 27 patients (66.7%) with subfoveal CNV over the course of more than 2 years. Suppressing CNV enlargement is required to maintain optimal postoperative visual acuity.

Keywords: age–related macular degeneration • vitreoretinal surgery • choroid: neovascularization