Case selection in macular relocation surgery for age related macular degeneration.
BACKGROUND
To date there has been no randomised controlled trial demonstrating the safety and efficacy of macular relocation surgery (MRS) for age related macular degeneration (AMD). Vision can be improved in some patients and made worse in others despite successful surgery or because of complications.


OBJECTIVE
To determine which patients would benefit from MRS.


METHODS
Twenty nine patients with exudative AMD took part in a prospective, non-comparative, interventional study. Macular relocation surgery involved phacoemulsification, vitrectomy, 360 degrees retinotomy, excision of choroidal neovascular membrane, and macular relocation using an infusion of 5-fluorouracil and low molecular weight heparin as adjuvant to prevent proliferative vitreoretinopathy. Patients underwent protocol refraction preoperatively and six-monthly postoperatively by designated optometrists. Preoperative fundus fluorescein angiograms were read by masked observers and the lesions were classified according to a set protocol. The main outcome measures were visual improvement, final vision of better than 20/400, reading speed, critical print size. Logistic and multiple stepwise linear regressions were used to identify independent factors which predicted the main outcomes.


RESULTS
Preoperative visual acuity (20/120 or worse) and lesion type (predominantly classic or submacular haemorrhage) were significantly associated with visual improvement (coefficient of regression B = 26.8, p<0.001 and B = 14.9 with p = 0.045 respectively). There were no significant independent factors which predicted a final distance logMAR visual acuity of 1.3 (20/400) or any arbitrary definition of blindness.


CONCLUSIONS
The study showed that it was possible to select cases that were more likely to experience an improvement in vision following MRS.
Wong
D
D
St Paul's Eye Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK. shdwong@liverpool.ac.uk
Stanga
P
P
Briggs
M
M
Lenfestey
P
P
Lancaster
E
E
Li
K K
KK
Lim
K S
KS
Groenewald
C
C
D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D020256:Choroidal Neovascularization / Q000517:prevention & control; D005472:Fluorouracil / Q000627:therapeutic use; D005500:Follow-Up Studies; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D016014:Linear Models; D008266:Macula Lutea / Q000601:surgery*; D008268:Macular Degeneration / Q000601:surgery*; D008875:Middle Aged; D018579:Patient Selection; D018918:Phacoemulsification; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy; D018630:Vitreoretinopathy, Proliferative / Q000517:prevention & control
D006495:Heparin, Low-Molecular-Weight; D005472:Fluorouracil