Complications.

<p>Complications.</p

Long-term results after limited macular translocation surgery for wet age-related macular degeneration

<div><p>Purpose</p><p>To evaluate the long-term results of limited macular translocation (LMT) surgery with radial chorioscleral outfolding in patients with wet age-related macular degeneration (AMD) and subfoveal choroidal neovascularization (CNV). In addition, to identify the factors associated with the final best-corrected visual acuity (BCVA).</p><p>Methods</p><p>The medical records of 20 eyes of 20 consecutive patients (65.2±9.8 years) who had undergone LMT for the treatment of wet AMD and were followed for at least 5 years, were reviewed. The surgical outcomes including the BCVA, degree of foveal displacement, and complications were recorded.</p><p>Results</p><p>The mean foveal displacement was 1332 ± 393 μm after the LMT. The CNV was removed in 16 eyes and photocoagulated in 4 eyes. The mean preoperative VA was 0.83 ± 0.33 logMAR units which significantly improved to 0.59 ± 0.37 logMAR units at 1 year after the surgery (<i>P</i> = 0.015). This BCVA was maintained at 0.59 ± 0.41 logMAR units on the final examination. The final BCVA was significantly correlated with that at 1 year after the surgery (r = 0.83, <i>P</i><0.001). Multiple linear regression analysis showed that the final BCVA was significantly correlated with the BCVA at 1 year after the surgery (<i>P</i><0.001), a recurrence of a CNV (<i>P</i> = 0.001), and the age (<i>P</i> = 0.022).</p><p>Conclusions</p><p>LMT improves the BCVA significantly at 1 year, and the improved BCVA lasted for at least 5 years. These results indicate that the impaired function of the sensory retina at the fovea can recover on the new RPE after the displacement for at least 5 years. The ability to maintain good retinal function on the new RPE for a long period is important for future treatments of CNVs such as the transplantation of RPE cells and stem cells.</p></div

Characteristics of the patients with age-related macular degeneration.

<p>Characteristics of the patients with age-related macular degeneration.</p

Multiple regression analysis of factors contributing to the final visual acuity.

<p>Multiple regression analysis of factors contributing to the final visual acuity.</p

Long-term results after limited macular translocation surgery for wet age-related macular degeneration - Fig 4

<p><b>Scatter plots of the BCVA before and 1 year after surgery (A), and the BCVA 1 year after surgery and 5 year after surgery (B) and at the final examination (C) are shown.</b> The BCVAs are plotted in logarithm of the minimum angle of resolution (logMAR) units. The BCVA of 13 eyes without a recurrence (filled circle) and 7 eyes with a recurrence (open circle). The mean BCVA at 1 year after surgery is not significantly correlated with that before surgery, but is significantly correlated with that at 5 year after the surgery (r = 0.86, <i>P</i> <0.001) and the final follow-up examination (r = 0.83, <i>P</i> <0.001). The BCVA at 1 year after surgery was 20/200 or worse in 4 eyes (20%), 20/200 to 20/60 in 11 eyes (55%), and 20/50 or better in 5 eyes (25%). The final BCVA was 20/200 or worse in 6 eyes (30%), 20/200 to 20/60 in 9 eyes (45%), and 20/50 or better in 5 eyes (25%) (D).</p

Intraoperative photographs of limited macular translocation surgery (LMT).

<p>Creating a retinal detachment (white arrowheads) using a 39-gauge injection cannula to infuse balanced salt solution (BSS) (A). White arrows show a choroidal neovascularization (CNV). Clips were placed along a diagonal line beginning 2 mm posterior to the lateral rectus muscle insertion to the superior oblique muscle insertion (B). The new fovea is shown by the white arrowheads. The CNV membrane was grasped with subretinal forceps (white arrows) and removed (C).</p

Mean best-corrected visual acuity (BCVA) ± standard error of the means (± SEM) before and at 1, 2, 3, 4, 5 years and final visit following the LMT surgery.

<p>The BCVA was significantly improved at 1 year after surgery (<i>P</i> = 0.015), and the improved BCVA was maintained for at least 5 years after the surgery. In comparison with the preoperative BCVA, the BCVAs at all of the 3 postoperative time points (Year 1, Year 5, and the final examination) are improved by 2 or more lines of the visual acuity chart in 9 of the 20 eyes (45%), no change in 8 (40%), and decreased in 3 eyes (15%).</p

Representative eye before and after limited macular translocation surgery (LMT).

<p>Fundus photographs showing a subfoveal choroidal neovascularization (CNV) with serous detachment, and minimal subretinal hemorrhage at the macula before the surgery (A). The macula was moved inferiorly to the new healthy RPE (black arrowheads), and the CNV can be seen (white arrowheads) after the LMT. The CNV was removed 2 weeks after the LMT, black arrows point to the scar after the CNV was removed (C). An expanded atrophic area can be seen 2 years after the surgery (D). A spectral domain optical coherence tomographic image showing that the anatomic structure is normal at the fovea 6 years after surgery (E).</p