Surgical treatment of subfoveal neovascularization in myopia: macular translocation vs surgical removal

Abstract

PURPOSE: To compare the visual outcome of two different surgical approaches for subfoveal neovascularization in degenerative myopia: macular translocation and surgical removal of choroidal neovascularization (CNV). DESIGN: Interventional case series. METHODS: Retrospectively, 32 eyes with degenerative myopia (axial length over 26 mm or refraction over −6 diopters) and subfoveal CNV of 32 consecutive patients operated on by either surgical removal of CNV or limited macular translocation were reviewed. Surgical removal of CNV was performed in 18 eyes and limited macular translocation with a twofold suture in 14 eyes. The main outcome measurements were best-corrected visual acuity (BCVA) and findings from fluorescein angiography. Postoperatively, mean ± SD follow up was 14 ± 15 months (range, 6–48 months) in the removal group and 11 ± 4 months (range, 6–24 months, P = .37) in the translocation group. RESULTS: In both groups, there was no significant difference in preoperative age, sex, refractive error, or BCVA. The average of postoperative BCVA was statistically better after macular translocation (10 ETDRS lines or 20/100) than after surgical removal (6 lines 10/125, P = .019). Visual acuity improved by 3.8 lines after macular translocation and was unchanged after surgical removal (−0.7 line, P = .011). Macular translocation was successful in shifting the CNV to an extrafoveal location in 11 out of 14 eyes. Mean foveal displacement of all 18 translocated eyes was 695 ± 426 μm (range, 100–1520 μm). Recurrence of CNV occurred in seven eyes (39%) after surgical removal and in two eyes (14%) after translocation. Retinal detachment occurred in two eyes in each group. CONCLUSION: In this retrospective study, eyes with degenerative myopia and subfoveal neovascularization treated with limited macular translocation had better visual acuity recovery than eyes treated with surgical removal of the choroidal neovascularization. Further studies are required to confirm these results.