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Application of subretinal fluid to close refractory full thickness macular holes: treatment strategies and primary outcome: APOSTEL study. Graefes Arch Clin Exp Ophthalmol 2020. [DOI: 10.1007/s00417-020-04735-3 10.1007/s00417-020-04735-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Application of subretinal fluid to close refractory full thickness macular holes: treatment strategies and primary outcome: APOSTEL study. Graefes Arch Clin Exp Ophthalmol 2020; 258:2151-2161. [PMID: 32583283 DOI: 10.1007/s00417-020-04735-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/14/2020] [Accepted: 05/06/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Persisting macular holes (PMH) after surgical release of any epiretinal traction of the vitreous and adjacent membrane may rely on secondary firm adhesions between the retracted retina and adjacent retinal pigment epithelium. Secondary application of subretinal (SR)-fluid may release these adhesions followed by an anatomical closure. METHODS Twelve surgeons applied in a consecutive case series SR-fluid in 41 eyes with PMH and reported retrospectively their initial surgical, anatomical and functional experience with this approach. RESULTS The mean duration of the MH prior to SR-fluid application was 17 months (6-96 months). The mean age of the patients at the time of surgery was 72 years (54-88). The mean preoperative aperture diameter of the opening was 1212 μm (239-4344 μm), base diameter 649 μm (SD 320 μm). The mean preoperative BCVA prior to surgery was 0.1 (0.01-0.3). All patients (41/41) complained about reduced BCVA and a significant central scotoma (negative scotoma) in their central field of vision. The secondary closure rate for our PMH was 85.36% (35 out of 41 eyes) at 6 weeks after surgery. The postoperative BCVA improved to 0.22 (0.02-0.5). The application of SR-fluid was not associated with major intraoperative adverse effects. CONCLUSION Remaining SR-adhesions may inhibit PMH closure. Their release by application of SR-fluid will lead to a fast and immediate anatomical closure in many cases without serious adverse events.
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Meyer CH, Adamcova M, Rodrigues EB, Stanzel B, Koss MJ. [Closure of Persisting Full Thickness Macular Holes by Subretinal Fluid Application: Technical Approach and Surgical Considerations]. Klin Monbl Augenheilkd 2020; 238:173-178. [PMID: 32289849 DOI: 10.1055/a-1120-8673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Firm adhesions between the retina and adjacent retinal pigment epithelium (RPE) may prevent the closure of macular holes (MH) after chromovitrectomy. Controlled application of subretinal (SR) fluid with BSS may release these adhesions leading to closure of the retracted retina in large and or refractory macular holes. METHODS For a standardized procedure, it is recommended to exclude residues of epiretinal membranes on the retinal surface preoperatively at OCT or intraoperatively by means of vital dyes. Intraoperatively, a perfluorocarbon (PFO) bubble is placed above the MH and lowers the infusion bottle of 20 mmHg. Subsequently, SR-fluid blebs are applied in the upper, temporal and inferior quadrants with a subretinal 41-gauge cannula. After removing decalin bubble, the SR-detachment is enlarged toward the foveal center. This is essential to achieve a complete detachment of the outer macular edges from the RPE. The MH can be closed by a temporary gas endotamponade. RESULTS With a standardized procedure, the operation can be carried out safely and with minimal effort. Additional measures, such as care for bubble-free SR-fluid sands or machine assistance, were added. In a pilot study, experienced VR surgeons performed the SR-fluid application safely and without complications. The preoperative diameter of the MH was 1150 µm (651 - 2350 µm). The secondary closure rate for our PMH was 80.9%. CONCLUSION SR-adhesions seem to have a previously unnoticed component in persistent macular holes. An SR-fluid application can be carried out quickly, safely and with minimal material effort. The initial results show a high secondary closure rate.
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Affiliation(s)
- Carsten H Meyer
- Augenärzte Graubünden, Davos, Schweiz.,Department of Ophthalmology, Faculty of Medicine, Federal University of São Paulo, Brasilien
| | | | - Eduardo B Rodrigues
- Department of Ophthalmology, Faculty of Medicine, Federal University of São Paulo, Brasilien.,Department of Ophthalmology, University of St. Louis, St. Louis, USA
| | - Boris Stanzel
- Augenklinik, Knappschaftsklinikum Saar GmbH, Krankenhaus Sulzbach
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Meyer CH, Borny R, Horchi N. Subretinal fluid application to close a refractory full thickness macular hole. Int J Retina Vitreous 2017; 3:44. [PMID: 29209516 PMCID: PMC5702967 DOI: 10.1186/s40942-017-0094-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/25/2017] [Indexed: 11/10/2022] Open
Abstract
Background To close a refractory full thickness macular hole (FTMH) by adjacent subretinal fluid application to release the elastic retina from the retinal pigment epithelium (RPE). Case presentation A 83 years old patient presented an old FTMH with a diameter of 1444 μm. After confirming intraoperatively the complete release of the epiretinal membrane around the FTMH, we installed 3 small subretinal blebs around the hole, to release the adjacent retina from the RPE. The mobilized retina was gently moved towards the macular center. A silicone oil tamponade was installed to secure a proper healing and observation of the FTMH. The closure of the 1444 μm FTMH was seen on indirect ophthalmoscopy and confirmed by OCT 5 days after surgery by restoring the retinal architecture. A late reopening was not apparent at the postoperative observations. Visual acuity improved from hand motion to 20/200 at 4 weeks postoperative. Conclusion Although FTMH develop by epiretinal tangential traction, large FTMH may persist even after complete release of its epiretinal traction. Subretinal fluid application may release the flexible retina from the RPE to achieve a relocation at the central fovea facilitating an anatomical closure of the macular hole.
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Affiliation(s)
| | - Robert Borny
- Pallas Clinics, Bahnhofplatz 2, 5000 Aarau, Switzerland
| | - Nicole Horchi
- Pallas Clinics, Bahnhofplatz 2, 5000 Aarau, Switzerland
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Denion E, Ordonez JR, Klein JC, Glacet-Bernard A, Walter T, Caputo G. Redistribution of the neurosensory retina in inferior limited macular translocation: an evaluation using image registration. Graefes Arch Clin Exp Ophthalmol 2006; 245:437-42. [PMID: 16944187 DOI: 10.1007/s00417-006-0408-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2006] [Accepted: 07/04/2006] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The present work aims to demonstrate the role of redistribution of the neurosensory retina (RNR)-that is, retinal tissue stretching and compression-in inferior limited macular translocation (LMT), to perform displacement mapping all over the area centralis, and to try and improve displacement evaluation precision. METHODS Using piecewise linear image registration (through Matlab) on indocyanine green angiographic frames, we have evaluated the deformation (on both the retinal and choroido-scleral layer) of a pre-operative grid superimposed on the area centralis, plotted displacement vectors all over the area centralis, and calculated a scale ratio between pre- and post-operative frames. The scale ratio tests whether or not the same physical distance is represented by the same distance on these frames. RESULTS The choroido-scleral layer is not deformed following surgery. The retinal layer shows areas of stretching and compression, demonstrating the RNR. Displacement vectors feature a rotating pattern around the optic disk (except if a macular fold exists) and a positive naso-temporal gradient. The median scale ratio is 3.8% (2.5% to 5.8%). CONCLUSIONS LMT involves RNR accounting for inferior retinal displacement, despite the supposedly limited internal scleral shortening. Our study confirms that the optic disk temporal edge is the displacement axis (except if a macular fold exists). Our method, unaffected by a non-zero scale ratio, provides more precision than previously published.
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Affiliation(s)
- Eric Denion
- Ecole Nationale Supérieure des Mines de Paris, Centre de Morphologie Mathématique, 35 Rue Saint Honoré, 77305, Fontainebleau Cedex, France.
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Pan JCH, Heng WJ, Eong KGA. Surgically-induced Corneal Changes Following Macular Translocation with Punctate Retinotomies and Chorioscleral Infolding (Limited Macular Translocation). ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2006. [DOI: 10.47102/annals-acadmedsg.v35n8p588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Introduction: To report the sequential changes in corneal topography and astigmatism following limited macular translocation.
Clinical Picture and Treatment: A 45-year-old-man who underwent limited macular translocation for idiopathic subfoveal choroidal neovascularisation in the right eye was evaluated by corneal topography and manifest refraction preoperatively and serially for 1 year postoperatively.
Outcome: An increase in astigmatism with corneal steepening along meridians corresponding to the area of chorioscleral infolding was observed and this persisted for 1 year after surgery. Vector-analysed astigmatic change showed significant surgically induced astigmatism of 2.18 dioptres (D) X 52.9 degrees, 2.17 D X 57.8 degrees and 2.56 D X 59.1 degrees at 2, 5 and 12 months after surgery respectively.
Conclusion: Surgically induced corneal changes are evident after limited macular translocation and may remain up to 1 year after surgery.
Key words: Astigmatism, Choroidal neovascularisation, Corneal topography, Ophthalmologic surgical procedure
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Falkner CI, Leitich H, Frommlet F, Bauer P, Binder S. The end of submacular surgery for age-related macular degeneration? A meta-analysis. Graefes Arch Clin Exp Ophthalmol 2006; 245:490-501. [PMID: 16673139 DOI: 10.1007/s00417-005-0184-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2005] [Accepted: 10/07/2005] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The aim of this meta-analysis was to summarize and to discuss the results of the four main submacular surgical procedures for age-related macular degeneration (AMD) as reported in the literature through 2004 and to compare them to the Submacular Surgery Trials (SST) data. METHODS The existing data in the literature on submacular surgery for AMD from 1992 to 2004 were evaluated. The main outcomes were proportion of patients with two or more lines of improvement in visual acuity (VA) and proportion with two or more lines of deterioration in VA after surgery. RESULTS Eighty-eight studies including 1,915 cases met the inclusion criteria. Estimates for the treatment outcome within the four groups of treatment based on a logistic regression model gave comparable results for removal of choroidal neovascularization (CNV) (improvement of VA 28%, deterioration of VA 25%), macular translocation (improvement of VA 31%, deterioration of VA 27%), and for transplantation of pigment epithelium (improvement of VA 22%, deterioration of VA 21%). Estimates for removal of subretinal hemorrhage were significantly different (improvement of VA 62%, deterioration of VA 13%). CONCLUSIONS Selected case series showed superior results of VA compared to the SST. The question of whether this is due to selection bias that seems inevitable when dealing with medium-sized nonrandomized case series or due to better results in single centers cannot be answered. In our opinion there still seem to be indications for submacular surgery such as in patients with AMD with low preoperative VA due to large hemorrhagic or fibrotic membranes or nonresponders to photodynamic therapy (PDT).
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Affiliation(s)
- Christiane I Falkner
- Department of Ophthalmology, Rudolf Foundation Clinic, The Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Juchgasse 25, 1030, Vienna, Austria.
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Smith BT, Park CH, Federman JL, Sarin LK, Martidis A. EFFICIENT TOTAL DETACHMENT OF THE RETINA FOR FULL MACULAR TRANSLOCATION. Retina 2006; 26:580-3. [PMID: 16770267 DOI: 10.1097/00006982-200605000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cahill MT, Toth CA. Macular Translocation with 360-Degree Peripheral Retinectomy. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50158-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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de Juan E, Fujii GY. Limited Macular Translocation. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50157-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Park HS, Kim JY, Shin JP, Choi YJ, Kim SY. Effect of experimental scleral shortening on axial length of the rabbit eye. KOREAN JOURNAL OF OPHTHALMOLOGY 2005; 19:101-5. [PMID: 15988924 DOI: 10.3341/kjo.2005.19.2.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the change of axial length (AL), intraocular pressure (IOP), and corneal astigmatism after scleral shortening with scleral invagination in the rabbit eye. METHODS The authors performed scleral shortening (3 mm) with scleral invagination in two groups of 6 eyes each: 180 degrees (group 1) and 360 degrees (group 2). RESULTS Average AL shortening was more prominent in group 2 (0.5 +/- 0.17 mm) than in group 1 (0.37 +/- 0.29 mm), but the difference was not statistically significant. IOP increased immediately after the procedure and was maintained at a high level through 2 months postoperatively. Induced corneal astigmatism was more prominent in group 1 than in group 2. The difference was statistically significant in group 1 (p<0.05) but not in group 2. CONCLUSIONS In the scleral shortening with scleral invagination procedure, a large amount of scleral invagination resulted in more shortening of axial length, but there was more corneal astigmatism in 180-degree invagination of the sclera than in 360-degree. Further research is required to determine the effect of the extent of scleral invagination on the change of these values.
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Affiliation(s)
- Han Sang Park
- Department of Ophthalmology, Kyungpook National University College of Medicine, Daegu, Korea
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Abstract
The development of increasingly refined vitreoretinal surgical techniques has resulted in a variety of surgical procedures for age-related macular degeneration (AMD). These have included submacular surgery with removal of choroidal neovascular membranes and subretinal blood, intraoperative lysis of feeder vessels, pneumatic displacement of subretinal blood and macular translocation surgery. The goals of these procedures have been to improve upon the poor natural history of exudative AMD and restore useful central vision. This article reviews the varied approaches, results and complications of the surgical management of AMD.
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Affiliation(s)
- Stephen M Conti
- University of Toronto, Sunnybrook and Women's College Health Sciences Centre, Ontario, Canada
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Mateo C, Moreno J, Rosales G, Lechuga M, Castillo R, Vaz F, Corcóstegui B. Two-year results of macular translocation with scleral infolding in myopic choroidal neovascularisation. Semin Ophthalmol 2005; 19:29-42. [PMID: 15590532 DOI: 10.1080/08820530490520013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To assess the two year outcome following macular translocation (MT) with scleral infolding in the management of myopic subfoveal choroidal neovascularisation (CNV). DESIGN Prospective, clinical interventional noncomparative consecutive case series. PARTICIPANTS 79 eyes of 79 patients with myopic subfoveal CNV and less than 6 months of duration of the symptoms. INTERVENTION MT with scleral infolding. MAIN OUTCOME MEASURES Visual Acuity (VA), reading ability of 12 point Arial letter sentences at a reading distance without magnifying systems and foveal displacement. RESULTS Mean preoperative VA was 20/125, after two years the mean VA was 20/80. Reading ability of 12 point Arial letter sentences at a reading distance (33 cm) was obtained in 59% of the eyes at one year, descending to 43% at two years. Mean foveal displacement after surgery was 942 microns. Intraoperative complications have been: retinal breaks (21.5%) and choroidal haemorrhage not affecting the posterior pole (3.7%). Main postoperative complications have been: Insufficient foveal displacement: 20%; Retinal detachment: 8.8%; Subfoveal recurrence: 28%; macular fold: 2.5% and macular hole: 1.2%. CONCLUSION MT with scleral infolding offers the opportunity to recover central vision and reading ability in patients with myopic CNV but it remains unpredictable.
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Affiliation(s)
- Carlos Mateo
- Instituto de Microcirugía Ocular, Universidad Autónoma de Barcelona, Barcelona, Spain.
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Inoue M, Shinoda K, Ishida S, Shinoda H, Nagai N, Noda K, Oguchi Y. TREATMENT OF RETINAL DETACHMENT AFTER MACULAR TRANSLOCATION WITH SCLERAL INFOLDING: PRESERVATION OF MACULAR TRANSLOCATION. Retina 2004; 24:962-4. [PMID: 15579997 DOI: 10.1097/00006982-200412000-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Makoto Inoue
- Department of Ophthalmology, Keio University, Tokyo, Japan.
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Schmidt JC, Meyer CH, Mennel S, Hörle S. Makulatransposition als Therapieoption bei subfovealer Neovaskularisation. SPEKTRUM DER AUGENHEILKUNDE 2004. [DOI: 10.1007/bf03163596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Güven D, Panzan CQ, Humayun MS, De Juan E. Use of rotational sutures for limited retinal translocation: a new technique for superior limited macular translocation. Am J Ophthalmol 2004; 137:901-7. [PMID: 15126156 DOI: 10.1016/j.ajo.2004.01.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2004] [Indexed: 11/18/2022]
Abstract
PURPOSE To report a modified surgical technique for retinal translocation in eyes with subfoveal choroidal neovascularization. DESIGN Experimental animal study. METHODS Nine pigmented rabbits were used consecutively to apply this technique. Placement of inferotemporal scleral imbrication sutures was followed by vitrectomy with posterior hyaloid separation. Balanced saline solution (BSS) was injected subretinally with a 30G needle or with a 39G hydrodissection cannula and viscous fluid injector to detach one retinal quadrant. Under low intraocular pressure, the imbrication sutures were tied, the sclerotomy sites were closed, and intravitreal air tamponade was injected. Rotation sutures were passed and the eye globe was rotated approximately 90 degrees counterclockwise. The rotation sutures were removed after 24 hours. Retinal photographs were taken and fundus examination was performed on postoperative days 1, 2 and 7. The animals were sacrificed after 7 to 10 days for postmortem macroscopic examination. RESULTS The entire procedure was performed in nine eyes of nine rabbits. In eight eyes, translocation could be seen on the first postoperative day after removal of the rotation sutures. The average amount of translocation was 667 microm (range: 500-800 microm) in a nasal to inferonasal direction. Vitreous hemorrhage occurred at the end of surgery in one eye due to hypotony. Iatrogenic small retinal breaks occurred in 2 eyes but did not prevent completion of the procedure. There was only a temporary hyperemia of the eyelids and conjunctiva. CONCLUSION Limited retinal translocation using rotational sutures provided a predictable amount of translocation in the planned direction. This technique is expected to be useful for superior macular translocation in humans.
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Affiliation(s)
- Dylek Güven
- Doheny Retina Institute, Doheny Eye Institute, Keck School of Medicine of the University of Southern California, 1450 San Pablo Street, Los Angeles, CA 90033, USA.
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Kent DL, Fujii GY, Pieramici DJ, Reynolds SM, Melia M, Rossi JV, Humayun MS, Caffey S, De Juan E. Angiographic characteristics in patients undergoing macular translocation for subfoveal choroidal neovascularization secondary to age-related macular degeneration. Retina 2003; 23:152-8. [PMID: 12707592 DOI: 10.1097/00006982-200304000-00003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To review in a standardized fashion pre- and postoperative fluorescein angiographic characteristics in patients undergoing limited macular translocation (LMT) with scleral imbrication to treat subfoveal choroidal neovascularization (SFCNV) secondary to age-related macular degeneration (AMD). The current study was undertaken to assess any potential effects of the translocation procedure on altering the angiographic characteristics of SFCNV before laser photocoagulation. METHODS A consecutive series of patients undergoing LMT for AMD was identified retrospectively. The pre- and postoperative fluorescein angiograms were reviewed in a masked fashion. Angiographic characteristics evaluated included pre- and postoperative lesion components, stability of lesion, and the amount of retinal translocation obtained. RESULTS Eighty-eight patients (90 eyes) had angiograms of adequate quality to permit evaluation. Time between the preoperative and the prelaser angiogram ranged from 2 to 84 days (median 7.5 days). Neovascular complexes remained unchanged or decreased in size in 79% of patients. There was no statistically significant difference in lesion size between the pre- and postoperative periods (P = 0.34). Retinal movement ranged from 160 microm to 3,320 microm (median 960 microm), with 61% of cases undergoing effective translocation (i.e., the fovea was moved away from the neovascular complex). None of the lesion components or demographic factors evaluated affected the amount of translocation obtained. Larger lesions were more likely to remain subfoveal following translocation (P = 0.004). CONCLUSION The size and lesion characteristics appear relatively stable following translocation. Amount of retinal movement is not associated with angiographic lesion characteristics. Only size was associated with achievement of desired translocation in the final model, with large lesions being less likely to achieve desired translocation. In our study group, the amount of retinal translocation was variable with 61% of cases undergoing effective translocation.
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Affiliation(s)
- David L Kent
- Vitreoretinal Service, Wilmer Institute, Johns Hopkins University, Baltimore, Maryland, USA
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Falkner CI, Binder S, Leitich H. Systematischer Review der submakulären Chirurgie bei altersabhängiger Makuladegeneration (AMD). SPEKTRUM DER AUGENHEILKUNDE 2003. [DOI: 10.1007/bf03162736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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