Macular translocation with chorioscleral outfolding: a pilot clinical study

Abstract

PURPOSE: A new surgical technique to translocate the macula was used to treat patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration (AMD). DESIGN: Prospective, interventional case series. METHODS: Twenty-five eyes of 25 patients underwent macular translocation with either circumferential or radial chorioscleral outfolding using three clip sizes: 2-mm, 3-mm, and 4-mm. Postoperative photocoagulation was performed on only those eyes that had an extrafoveal choroidal neovascular membrane following surgery. RESULTS: The surgery successfully displaced the fovea in 22 (88%) of the eyes. The median postoperative foveal displacement was 1142 μm (range 0 to 3200 μm). Patients who had radial outfolding with 4-mm clips had the greatest displacement of the fovea (range 1644 to 3200 μm median 1977 μm). The fovea was successfully displaced to a location outside the choroidal neovascular membrane in 17 (68%) of the 25 eyes. The best-corrected visual acuity improved in 11 eyes (median, 17 letters), remained unchanged in 4 eyes, and decreased in 10 eyes (median, 12 letters). Visual acuity increased by a median of 2 letters. The final best-corrected visual acuity was 20/64 in 3 eyes; 20/80 in 3 eyes; 20/100 in 4 eyes; 20/126 in 4 eyes; 20/200 in 4 eyes; 20/250 in 4 eyes; and 20/400 in 3 eyes. CONCLUSIONS: Macular translocation with radial chorioscleral outfolding using 4-mm clips resulted in the best foveal displacement and improvement in visual function, and was associated with the least amount of vision loss and complications. Further refinements are needed to make this surgical procedure more predictable, and more research (randomized clinical trials) is needed to determine the role of macular translocation in the treatment of subfoveal choroidal neovascularization in patients with AMD.