Central and Pericentral Retinal Sensitivity After Macular Translocation Surgery

Abstract

To evaluate the separate contribution of the retina versus retinal pigment epithelium (RPE)-choriocapillaris to visual function after treatment of neovascular age-related macular degeneration by measuring retinal sensitivity across three areas after macular translocation surgery. Using the Nidek microperimeter-1, we tested retinal sensitivity across three areas in 35 patients after macular translocation surgery. Microperimetry scores ranged from -2 (no response to brightest stimulus) to 20 (response with 20 dB neutral density filtering). Median retinal sensitivity score (MRSS) for the central 10-degrees (Area 1, fovea translocated over healthier RPE) was compared with acuity, reading speed and MRSS of adjacent areas: Area 2, retina over site of choroidal neovascularization removal and Area 3, retina over undisturbed RPE. In 27 of 35 eyes in this study (77%), the MRSS for Area 1, was greater than Area 2. Area 1 was a median of 3.0 decibels (dB) greater in sensitivity (range, 16 greater-2 lower) than Area 2 (P < or = 0.001), and 5.0 dB lower (range, 2 greater-12 lower) than Area 3 (P < or = 0.001). The median of the MRSS (25th/75th percentile) for Areas 1, 2 and 3 were 2.0 (0.0/6.0), -2.0 (-2.0/-2.0) and 9 (4.0/12.0), respectively. The MRSS for Area 1 correlated with reading speed more than with acuity. Sensitivity of the translocated macula was significantly greater than in Area 2, retina over abnormal RPE-choriocapillaris, suggesting that disturbed RPE-choriocapillaris significantly limits retinal function. Area 1 sensitivity was lower than in retina unaffected by age-related macular degeneration over undisturbed RPE, suggesting that persisting retinal dysfunction can limit vision recovery.