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Macular translocation with radial scleral ouffolding: experimental studies and initial human results
J D Benner1, C H Meyer, B L Shirkey
1Delmarva Vitreoretinal Center, Salisbury, Maryland, USA.
Purpose:
Different techniques have been proposed for translocating the macula in patients with subfoveal neovascularization secondary to age-related macular degeneration. A new approach utilizing radial outfolding of the sclera was investigated.
Materials And Methods:
Surgical techniques and retinal displacement were evaluated in animal trials using metal scleral clips. Successful translocation and reattachment of the retina was achieved in eight rabbits (eight eyes). We conducted a retrospective review of macular translocation surgery, performed with radial scleral outfolding, in a series of five consecutive human patients (five eyes) using full-thickness transscleral mattress sutures.
Results:
After surgery, vision improved in two of five patients, with one patient achieving a visual acuity of 20/50. The mean angle of rotation was 11.5 deg (range 8.6 -15.1). The mean amount of foveal displacement was 1,276 pm (range 852-1,620). Complications included one case of retinal detachment, one of diplopia, and one of subretinal hemorrhage.
Conclusions:
Limited macular translocation by radial scleral outfolding can improve vision in selected patients. Radial evagination appears to be as effective as circumferential infolding.