Macular translocation with radial scleral ouffolding: experimental studies and initial human results.
OBJECTIVE
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.


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.
Benner
J D
JD
Delmarva Vitreoretinal Center, Salisbury, Maryland, USA.
Meyer
C H
CH
Shirkey
B L
BL
Toth
C A
CA
D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D020256:Choroidal Neovascularization / Q000209:etiology / Q000601:surgery*; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D008266:Macula Lutea / Q000637:transplantation*; D008268:Macular Degeneration / Q000150:complications; D008297:Male; D013508:Ophthalmologic Surgical Procedures; D011183:Postoperative Complications; D011379:Prognosis; D011817:Rabbits; D012189:Retrospective Studies; D012590:Sclera / Q000601:surgery*; D013536:Suture Techniques; D014792:Visual Acuity