[Macular translocation after photodynamic therapy: a case report]

Photodynamic therapy (PDT) and surgical macular translocation are concurrent treatment options for exudative age-related macular degeneration (ARMD). PDT is currently favoured because of positive study results and the non-invasive technique. We report a case of macular translocation with 360 degrees retinotomy after unsuccessful previous PDT for treatment of ARMD.

PDT with verteporfin was performed in the left eye of a 79-year-old patient with exudative ARMD and predominantly classic juxtafoveal choroidal neovascularisation (CNV). Because of continuing visual loss and deteriorating angiographic signs three months after PDT, a surgical macular translocation with 360 degrees retinotomy was performed successfully. During the surgery increased adhesion between the CNV and the retina was observed in contrast to patients without previous PDT. In a second step three months later, counter-rotation of the ocular globe was achieved by muscle surgery and the silicone oil was removed in the same session. The best spectacle corrected visual acuity improved from 0.1 before the surgery to 0.4 nine months thereafter (six Snellen lines). No CNV recurrence was observed. Patient satisfaction with the surgery outcome is high.

Macular translocation may be considered in cases of continuing deterioration after a previous PDT for treatment of exudative ARMD. Possible complications must be discussed with the patient. Intraoperatively, increased adhesion of CNV to the retina was observed, which might increase the risk of inadvertent damage to the retina during surgery.