Macular Translocation – First Experience

Overview

The age related macular degeneration (ARMD) is the most common cause of thecentral visual acuity loss in persons of agemore than 60 years in the well developedcountries. Rotation of the macula is nowadays a progressive method of choice oftreatment of the exsudative form of ARMD. The aim of this surgical technique isto relocate the neuroretinal epithelium of the central region of the retina toa position situated outside the border of the subfoveolar lesion.Three eyes of three patients (2 woman and one man) were operated on during theperiod between March and May 2001 at the Department of Ophthalmology of theSchool of Medicine, Charles University in Pilsen. The method used was the scleralimbrication, which belongs to methods designated as “limited translocation”. Themean age of the patients was 62 years and the follow up period was 2 years. Afterthe surgery the relocation of the fovea was observed in all three eyes. In two eyes,the postoperative period was complicated by tractional retinal detachment thatoccurred three weeks after the surgery as a consequence of progressive proliferativevitreoretinopathy (PVR). Both eyes with the retinal detachment werere-operated. In both of them, the repeated pars plana vitrectomy, epiretinalmembranes removal with relaxing retinectomy was performed and after maximalmobilization of the retina, the silicone oil implantation followed. In the second
patient, the postoperative period was complicated by elevation of the intraocularpressure and a radial retinal fold running from the encircling buckle indentationup to the macula. Slightly improved function was noticed only in the first patientafter following cataract surgery with intraocular lens implantation. In the twoother eyes, as noticed at the last follow up check, the postoperative complicationscaused severe decrease of the central visual acuity although the retina remainedattached.Macular translocation procedure is in stage of development and its surgicaltechniques are being further modified. The risk of postoperative complicationswith profound loss of central visual acuity corresponds to the level of the technicaldifficulty and extent of surgical intervention.

Key words:
age related macular degeneration, macular translocation