Limited Macular Translocation Research Articles

Surgical Treatment of Age-Related Macular Degeneration

Choroidal neovascularization (CNV) and geographic atrophy (GA) are serious and potentially devastating complications of age-related macular degeneration (AMD), a leading cause of blindness in the developed world. While anti-vascular endothelial growth factor (VEGF) therapies have emerged as the current standard treatment of choice for choroidal neovascularization, the requirement for indefinite injections places a tremendous burden on physicians and patients, and may have disappointing outcomes in hemorrhagic neovascular AMD. No superior agents exist to treat large subretinal hemorrhage and geographic atrophy. Over the years, several vitreoretinal surgical approaches have been developed to treat macular degeneration, and these surgical options may still play a role in the management of specific complications of AMD. This review summarizes the principles, techniques, and results of surgical treatments for neovascular and non-neovascular age-related macular degeneration, with emphasis on submacular surgery for removal of CNV, full and limited macular translocation, retinal pigment epithelium, and choroid transplants as well as treatment of thick subretinal hemorrhage.

Can macular translocation be a satisfactory management of subfoveal choroidal neovascular membrane?

To report histopathological observations regarding one of our macular translocation cases. We have performed macular translocation with 360 degree retinotomy since 1997, and limited macular translocation with or without subretinal membrane removal since 2002. One of our patients died on the fifth postoperative day, so extensive histological examination of the removed neovascular membrane and entire globe was performed. We found that pigment epithelium remained attached to the neurosensory retina during retinal separation, in which case the rotated fovea will be relocated in a partially devoided pigment epithelial zone. In addition, even after complete surgical removal of the membrane during macular translocation, large membrane remnants are still detectable by histological examination. In our opinion, macular translocation is not a satisfactory management of subfoveal neovascular membranes, because of changes in the pigment epithelium during surgery, and large subretinal neovascular membrane remnants.

Étude rétrospective comparant la translocation maculaire limitée et la photothérapie dynamique dans la néovascularisation choroïdienne rétrofovéale de la myopie forte

To analyze the results of limited macular translocation (MT) and photodynamic therapy (PDT) in subfoveal choroidal neovascularization due to degenerative myopia, with a minimum follow-up of 12 months. Retrospective review of 55 consecutive patients: 31 eyes were treated using PDT and 24 were operated on with the limited macular translocation technique with chorioscleral infolding described by de Juan. Before and after each treatment, a complete examination comprised visual acuity, fundus examination, fluorescein angiography, and optical coherence tomography. Mean follow-up was 14 months in the PDT group and 19 months in the MT group. The improvement in visual acuity was better in the MT group than in the PDT group and was correlated with younger age (p<0.001). At month 12, visual acuity improved by 3 ETDRS lines or more in 6 six eyes of the PDT group (19%), with no improvement over 6 lines. In the MT group, visual acuity improved by 3 lines in 14 eyes (58%) including 8 eight eyes (33%) with an improvement of 6 lines or more. Final visual acuity remain unchanged (+/-2 lines) in 16 eyes of the PDT group (66%) and 8 eight eyes of the MT group (33%), and decreased in 9 nine eyes in the PDT group (29%) versus 2 two eyes in the MT group (8%). Mean gain in visual acuity at 12 months was +3.5 ETDRS lines in the MT group and -0.1 line in the PDT group (p=0.001). The mean displacement of the fovea after translocation was 950 microm. The mMean number of PDT treatments was 2.3 during the 12-month follow-up. Limited macular translocation allowed provided a significant improvement in visual acuity in some eyes with subfoveal neovascularization in myopia, especially in young patients, and resulted in a moderate rate of complications. Longer follow-up and further controlled and randomized studies are required to confirm these encouraging findings.

Photodynamic Therapy vs Limited Macular Translocation in the Management of Subfoveal Choroidal Neovascularization in Pathologic Myopia: A Two-year Study

To compare the results of limited macular translocation and photodynamic therapy (PDT) in subfoveal choroidal neovascularization (CNV) attributable to pathologic myopia with a 24-month follow-up. Retrospective analysis of nonrandomized interventional clinical study. Retrospective review of 66 consecutive patients: 34 myopic eyes with subfoveal neovascularization treated by PDT and 32 operated on with the translocation technique. Translocation was considered principally when the lesion size was adequate (nasal inferior margin of the membrane less than half a disk diameter away from the center of the fovea) with duration of symptoms of less than four months. Main outcome measure was the postoperative change in visual acuity. In the translocation group, mean gain in visual acuity was greater than in the PDT group (+2.8 lines and -1.8 line, respectively, P = .001). In the translocation group, 55% of eyes gained 3 lines or more at two years compared with 10% in the PDT group. Sixty percent of eyes in the translocation group vs 40% in the PDT group had an improvement of at least five letters. Mean foveal displacement after translocation was 906 mum; postoperative complications included retinal detachment (three eyes), macular fold (one eye), and transient diplopia (four eyes). In young patients, the postoperative gain was better in both groups. In the translocation group, mean survival time for choroidal neovascularization recurrence was 40 months for patients younger than 40 years and 20 months for older patients. Translocation showed better results than PDT at two years. Further studies are required to confirm these findings.

Redistribution of the neurosensory retina in inferior limited macular translocation: an evaluation using image registration

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. 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. 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%). 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.

Surgically-induced Corneal Changes Following Macular Translocation with Punctate Retinotomies and Chorioscleral Infolding (Limited Macular Translocation)

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. 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. Surgically induced corneal changes are evident after limited macular translocation and may remain up to 1 year after surgery.

Pigment epithelial changes in young women treated with photodynamic therapy and limited macular translocation for classic choroidal neovascularisation

The objectives of this study were to report peculiar postoperative changes at the level of the retinal pigment epithelium (RPE) in young women with moderate or mild myopia and classic choroidal neovascularisation first treated unsuccessfully with photodynamic therapy (PDT) and afterwards with limited macular translocation. Retrospective review of two young myopic women who underwent PDT for treatment of idiopathic choroidal neovascularisation. Despite PDT, visual acuity decreased progressively, and limited macular translocation was performed 2-3 months later. During limited macular translocation (LMT) surgery, creation of retinal detachment using a 39-gauge cannula induced detachment of the RPE around the injection sites. Postoperatively, rounded flattened lesions were observed in both patients at the level of retinal pigment epithelium, with alternation of hyper- and hypopigmented rings around each site of injection. These alterations did not jeopardise visual recovery (20/25 and 20/40). The exceptional occurrence of pigment epithelial detachment during LMT surgery may suggest that PDT could predispose to these lesions by means of diffuse pigment epithelial changes. It encourages further studies to improve the understanding of RPE changes after PDT.

Initial Experience of Macular Translocation in Singapore – One-year Results

Introduction: This paper reports the 1-year results of the first 2 cases of macular translocation in Singapore. Clinical Picture: A 66-year-old female and a 45-year-old male Chinese presented with subfoveal choroidal neovascularisation (CNV) in their right eyes. The woman’s condition was secondary to pathological myopia while the man’s was idiopathic. Their preoperative best-corrected visual acuities were 6/15-2 and 6/30, respectively. Treatment: Both patients underwent macular translocation with punctate retinotomies and chorioscleral infolding (limited macular translocation) in their affected eye. Outcome: Both patients achieved effective macular translocation postoperatively. Their CNVs became extrafoveal and were ablated with conventional laser photocoagulation in the early postoperative period. They did not recur and their visual acuities improved to 6/9-1 and 6/12 at 1 year postoperatively, respectively. Conclusion: Macular translocation is a new treatment modality that offers patients with subfoveal CNV a chance of improving their vision, potentially to a level that may allow reading and driving.

Limited macular translocation: A clinicopathologic case report

Objective To illustrate the histopathologic findings in a patient who underwent limited macular translocation. Design Observational case report. Methods The patient underwent limited macular translocation for subfoveal choroidal neovascularization resulting from age-related macular degeneration. Thirty-one months after surgery, the patient had died and both eyes were obtained at autopsy. Serial sections through both maculas were obtained. Immunohistochemistry of the foveas with C10C10 and hCAR/LUMIf antibodies for rods and cones, respectively, was performed. Main outcome measures Histopathologic changes in the operated eye as compared with the fellow eye. Results There was no morphologic difference in the subfoveal retinal pigment epithelium, Bruch's membrane, or choriocapillaris, but there was a decreased cone density in the translocated fovea as compared with the fellow eye. Conclusions In this patient, the fovea was translocated without causing apparent change in the underlying retinal pigment epithelium, Bruch's membrane, or choriocapillaris. Although there may be some photoreceptor loss, the excellent visual recovery suggests that the retinal pigment epithelium underlying the translocated fovea is functionally adequate.

Limited macular translocation compared with photodynamic therapy in the management of subfoveal choroidal neovascularization in age-related macular degeneration

Purpose To compare the visual outcome of macular translocation (MT) versus photodynamic therapy (PDT) for subfoveal predominantly classic neovascularization in age-related macular degeneration (AMD). Design Nonrandomized clinical trial. Methods Retrospective review of 65 consecutive patients with subfoveal neovascularization due to AMD. The follow-up was at least 6 months. Main outcome criteria were final best corrected visual acuity and the gain in visual acuity. Results A total of 29 eyes were treated with PDT with verteporfin, and 36 underwent MT with chorioscleral infolding. Both groups were similar for age, refraction, and lesion size. The initial visual acuity was lower in the MT group than in the PDT group (20/200 versus 20/100). Mean follow-up was 11 months for the PDT group and 14 months for the MT group. The mean displacement of the fovea after translocation was 1,274 μm (range, 250 to 1,900 μm). Mean number of retreatment by PDT was 2.5. At 1 year, both groups had the same final visual acuity (20/200), but the improvement was more favorable in the MT group (gain of 0.7 line in the MT group versus loss of 3.4 lines in the PDT group, P = .007). One eye in the PDT group (4.3%) had a gain of 3 lines or more versus eight eyes (38%) in the MT group; the lesion size was larger in the PDT group than in MT group ( P = .036). Conclusion In this retrospective study, MT seemed to allow a better preservation of visual acuity than PDT in subfoveal neovascularization due to AMD. Further larger and controlled studies are required.

Use of rotational sutures for limited retinal translocation: a new technique for superior limited macular translocation

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 μm (range: 500–800 μm) 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.

Transposition of the anterior superior oblique insertion as a treatment for excyclotorsion induced from limited macular translocation

Purpose To evaluate the transposition of the anterior superior oblique insertion as a treatment for cyclovertical diplopia accompanied by an awareness of tilted image perceived with the affected eye induced from limited macular translocation (LMT). Design Observational case series. Methods Transposition of the anterior part of the superior oblique tendon combined with or without vertical muscle surgery on the affected eye was retrospectively studied in seven patients. Clinical outcome was assessed for binocular and monocular vision. A successful result was defined as restoration of single binocular vision (SBV) at distance and near examined with the Bagolini test with disappearance of a tilted image perceived in the affected eye. Results Six of seven patients (86%) became unaware of tilted image, and three patients (43%) obtained successful results after the strabismus surgery. Of these three patients with successful results, one (33%) patient recognized metamorphopsia, whereas two (67%) of the three patients with unfavorable results reported metamorphopsia. Patients with successful results showed a visual acuity of 20/25 or better in the affected eye and a significantly smaller difference in visual acuity between the two eyes than those patients with unfavorable surgical results (0.133 logarithm of the minimal angle of resolution for SBV(+) vs 0.675 logarithm of the minimal angle of resolution for SBV(-); P = .0255). Conclusions The relatively low success for restoration of SBV indicates that strabismus surgery is recommended for patients whose difference in visual acuity between the two eyes is small and who have a high level visual acuity of the affected eye.

Limited macular translocation for subfoveal choroidal neovascularization in age-related macular degeneration.

To examine the safety and efficacy of limited macular translocation followed by laser photocoagulation in the management of subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD). A prospective study was conducted on eight consecutive patients undergoing limited macular translocation followed by laser photocoagulation for the treatment of subfoveal classic CNV form of AMD. Patients were followed up for a minimum of 12 months. The magnitude of foveal translocation, visual outcomes and complications were assessed. In all cases the fovea was successfully translocated inferiorly, with a median displacement of 1.1 mm. Thermal laser photocoagulation was subsequently performed in all cases. Visual acuity improved in five eyes, remained unchanged in two eyes and worsened in one eye. The mean improvement in visual acuity was by 0.19 logMAR. At 12 months, six of the eight patients (75%) achieved Snellen visual acuity of at least 6/15, with four patients (50%) achieving Snellen visual acuity of 6/9. In this small case series, limited macular translocation was found to be an effective and reproducible means of treating small well-defined subfoveal CNV.

Limited macular translocation for the management of subfoveal choroidal neovascularization after photodynamic therapy

PurposeTo report our initial experience of limited macular translocation in patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration following photodynamic therapy with verteporfin. DesignInterventional case series. MethodsRetrospective review of four eyes of four consecutive patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration who underwent effective limited macular translocation following photodynamic therapy. The mean logarithm of minimal angle of resolution preoperative best-corrected visual acuity was 20/190 (range, 20/150 to 20/200), and in all eyes the visual acuity was 20/150 or worse. The major outcome measures were postoperative visual acuity and complications related to the surgery. ResultsThe mean postoperative follow-up was 6.75 months (range, 6–8 months). Postoperative best-corrected visual acuity improved by 2 or more Snellen lines of visual acuity in three of four eyes (75%) and remained within 1 line in one of four eyes (25%). The mean postoperative best-corrected visual acuity was 20/100 (range, 20/40 to 20/150), and in two of the four eyes (50%) the visual acuity achieved was 20/100 or better. No complication was observed. ConclusionsLimited macular translocation may be a viable option in patients who have previously undergone photodynamic therapy.

Limited macular translocation: current concepts.

Macular translocation is a promising treatment modality that offers patients a chance to improve their vision, potentially to a level that may allow reading and driving. Proper patient selection avoids surgery in eyes with permanently damaged central retina and identifies eyes with the greatest potential for good visual outcomes. Functionally, those patients with recent-onset subfoveal CNV without permanent foveal neurosensory retina damage have the greatest likelihood of good visual outcome. Use of fixation evaluation by means of the SLO appears to greatly optimize patient selection. Anatomically, the best candidates have small minimum desired translocations and healthy RPE-Bruch membrane-choriocapillaris complex beyond the borders of the lesion. The exact role of limited macular translocation for the management of subfoveal CNV in this era of photodynamic therapy remains to be evaluated, and a pilot multicenter, randomized, clinical trial is under way to compare the efficacy of limited macular translocation with photodynamic therapy in eyes with subfoveal CNV secondary to AMD.

Patient selection for macular translocation surgery using the scanning laser ophthalmoscope

Objectives To evaluate the use of the scanning laser ophthalmoscope (SLO) as a predictor for potential visual improvement in eyes with subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) undergoing limited macular translocation. Design Retrospective noncomparative case series. Participants Consecutive series of 71 eyes of 70 patients with subfoveal CNV secondary to AMD that underwent effective and uncomplicated limited macular translocation at the Wilmer Ophthalmological Institute. Methods Evaluation of the fundus microperimetry and fixation pattern was conducted on all patients using the Rodenstock scanning laser ophthalmoscope (G. Rodenstock Instrument GmbH, Munich, Germany) within 72 hours before surgery. Main outcome measures Sensitivity and specificity in addition to positive and negative predictive values of SLO findings for visual outcome after macular translocation. Results Stable fixation presented the highest positive predictive value for visual acuity equal to or better than 20/100 (30 of 33 = 0.91), and predominantly eccentric fixation had the highest negative predictive value for visual acuity worse than 20/100 (7 of 9 = 0.78). Sensitivity was higher for the presence of predominantly central fixation (42 of 48 = 0.87), and specificity was higher for relatively unstable/unstable fixation (20 of 23 = 0.87). Conclusions Eyes with stable and central fixation (without dense central scotoma) good preoperative visual acuity, and short length of symptoms are those with the greatest chance to achieve good vision after macular translocation. The knowledge of the fixation and microperimetry pattern enables better understanding of the macular function in eyes with AMD and may be useful for evaluation of baseline retinal cell viability. Incorporation of these testing modalities may help to optimize patient selection for macular translocation or other future techniques aimed at rescuing photoreceptors.

Inferior limited macular translocation for subfoveal choroidal neovascularization secondary to age-related macular degeneration: 1-year visual outcome and recurrence report

PURPOSE: To report the 1-year visual outcomes and incidence of persistent and recurrent choroidal neovascularization (CNV) after limited macular translocation (LMT) for subfoveal CNV in patients with age-related macular degeneration (ARMD).DESIGN: Interventional case series.METHODS: Retrospective review of 102 consecutive eyes of 101 patients that had the inferior limited macular translocation procedure for subfoveal choroidal neovascularization secondary to ARMD. The outcome measures were visual acuity at 12 months after surgery, change in visual acuity from baseline, the proportion of eyes with moderate (3 or more lines) or severe (6 or more lines) visual acuity loss, and cumulative incidence of persistent or recurrent CNV and its impact on visual acuity. Cumulative incidence was estimated using Kaplan-Meier survival analysis methods. Association between persistence and recurrence of CNV and the Snellen visual acuity recorded at each follow-up visit was evaluated using the Wilcoxon rank-sum test.RESULTS: Eighty-six (84.3%) of 102 eyes completed the 1-year follow-up. By 12 months postoperatively, 35 (40.7%) of the 86 eyes achieved visual acuity of 20/100 or better while 34 (39.5%) of the 86 eyes experienced 2 or more Snellen lines of visual improvement. In the 52 eyes with effective translocation and complete laser photocoagulation of the CNV complex with sparing of the sensory fovea, the estimated incidence of recurrence was 34.6% at 12 months (95% confidence interval of 21%–48%). Sixty-five percent of the recurrences were subfoveal and caused a decrease in visual acuity. There was a trend toward worse median change in visual acuity in eyes with persistent or recurrent CNV.CONCLUSIONS: Limited macular translocation for the treatment of subfoveal CNV secondary to ARMD is associated with improvement in visual acuity in approximately 39.5% of eyes and enables complete laser photocoagulation of the neovascular complex with sparing of the sensory macula in approximately 60.4% of eyes that complete 1 year follow-up. Persistence and recurrence of CNV are common after LMT and are important causes of vision loss. Further studies are warranted to more precisely evaluate the risks and benefits of LMT in ARMD.

Selection for inferior limited macular translocation on the basis of distance from the fovea to the inferior edge of the subfoveal choroidal neovascularization

PURPOSE: To assess the visual outcome of inferior limited macular translocation in eyes selected based on the distance from the fovea to the inferior edge of the subfoveal choroidal neovascularization. DESIGN: Interventional case series. METHODS: We performed inferior limited macular translocation in 12 consecutive eyes (12 patients) with age-related macular degeneration or polypoidal choroidal vasculopathy, in which the choroidal neovascularization did not extend for more than half of one disk diameter inferior to the fovea. RESULTS: In all eyes, the choroidal neovascularization was moved to an extrafoveal location. In seven of the 12 eyes, postoperative vision was 20/40 or better. The visual acuity improved by 2 or more lines in 11 eyes. CONCLUSION: Selection for inferior limited macular translocation on the basis of distance from the fovea to the inferior edge of the choroidal neovascularization may be associated with a greater likelihood of visual acuity improvement.

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

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.

Diplopia after limited macular translocation surgery

Purpose: Full macular translocation surgery relocates the fovea away from choroidal neovascularization, inducing significant postoperative torsional diplopia. In “limited macular translocation,” a saline-induced retinal detachment is followed by scleral imbrication with mattress sutures and spontaneous retinal reattachment. In this study, diplopia was characterized in patients treated with limited macular translocation. Methods: Two surgeons performed retinal translocation surgery on 250 patients over an 18-month time span. The extent and direction of the retinal translocation, and the amount and location of scleral imbrication, were recorded. All patients complaining of diplopia were referred for ocular motility evaluation and treatment. Results: Thirteen (5.2%) patients complained of occasional or constant diplopia. Imbricating sutures were placed supero-temporally in all cases. Inferior foveal translocation ranged from 200 to 2115 μm (median, 1750 μm). Visual acuity ranged from 20/40 to 20/400 in the operated eye. Prism-and-cover testing underestimated the strabismus when compared with subjective testing. In 3 patients, there was no shift on alternate-cover testing despite binocular diplopia. Excyclotorsion ranged from 0° to 16°. Diplopia resolved in 10 cases with prism; 3 required an occlusive filter for distortion or aniseikonia. One patient underwent successful strabismus surgery to eliminate dependence on prism glasses. Conclusions: Limited macular translocation only rarely produces symptomatic diplopia. Suprisingly, traditional prism-and-cover testing does not reliably quantify the misalignment. This may result from the combination of a persistent macular scotoma and a repositioned fovea relative to the peripheral retina. Prism therapy is generally satisfactory in the absence of retinal distortion or aniseikonia. (J AAPOS 2001;5:388-94)