Patient selection for macular translocation surgery using the scanning laser ophthalmoscope.
OBJECTIVE
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.


METHODS
Retrospective noncomparative case series.


METHODS
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.


METHODS
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.
Doheny Retina Institute at the Doheny Eye Center, University of Southern California, Keck School of Medicine, Los Angeles, California. Wilmer Ophthalmological Institute, The Johns Hopkins Hospital. Baltimore, Maryland, USA.
Gildo Y
GY
Fujii
Eugene
E
de Juan
Janet
J
Sunness
Mark S
MS
Humayun
Dante J
DJ
Pieramici
Tom S
TS
Chang
D000368:Aged; D000369:Aged, 80 and over; D020256:Choroidal Neovascularization / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005188:False Negative Reactions; D005260:Female; D005403:Fixation, Ocular; D006801:Humans; D007834:Lasers; D008266:Macula Lutea / Q000637:transplantation*; D008268:Macular Degeneration / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019721:Ophthalmoscopes; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests