Objective To measure the change in vision and visual outcomes at 12 months aft er macular translocation with 360°retinectomy (MT360) and silicone oil tamponad e in patients with bilateral vision loss resulting fr...Objective To measure the change in vision and visual outcomes at 12 months aft er macular translocation with 360°retinectomy (MT360) and silicone oil tamponad e in patients with bilateral vision loss resulting from subfoveal choroidal neov ascular membranes in age-related macular degeneration (AMD). Design A prospecti ve, interventional, consecutive, noncomparative case series. Participants Sixty -four patients with bilateral vision loss resulting from neovascular AMD. Metho ds Eligible patients had AMD with subfoveal choroidal neovascularization in the operative eye and a maximum of 6 months of central vision loss. Preoperative and 12-month postoperative evaluations included standardized testing of near and d istance acuity and reading speed. Patients underwent MT360 with silicone oil tam ponade, followed 2 months later by extraocular muscle surgery and silicone oil r emoval. Main outcome measures Change in distance acuity, near acuity, and readin g speed at 12 months after MT360 compared with those values before surgery. Resu lts Sixty-one patients were followed up for 12 months. All eyes were translocat ed successfully. Median distance acuity letter score improved from 62 letters (S nellen equivalent of approximately 20/125) before surgery to 69 letters (approxi mately 20/80) by 12 months after surgery (P=0.03). Median near acuity improved f rom 0.70 logarithm of the minimum angle of resolution (logMAR) units (approximat ely 20/100) before surgery to 0.44 logMAR units (approximately 20/55) at 12 mont hs (P < 0.001). Median reading speed improved from 71 words per minute (wpm) bef ore surgery to 105 wpm at 12 months after surgery (P < 0.001). At 12 months, dis tance acuity improved by 1 or more lines in 32 patients (52%). In patients with either preoperative distance or near acuity of 20/80 or better, 74%and 95%of patients, respectively, remained in this range of acuity. In patients with eithe r preoperative distance or near acuity of worse than 20/80, 40%and 48%of patie nts, respectively, improved to 20/80 or better. Postoperative retinal detachment developed in 5 patients (8%), with the macula involved in 2 patients, and all retinas were reattached successfully. Conclusions Macular translocation with 360 °retinectomy with silicone oil tamponade is effective in significantly improvin g visual function in patients with neovascular AMD, as demonstrated by the impro vement in distance and near acuity and reading speed at 12 months after surgery in these patients. Although this is a complex surgical intervention, patients wi th preoperative visual acuity of 20/80 or better at near or distance are highly likely to retain the 20/80 or better acuity at 12 months after surgery. Macular translocation with 360°retinectomy is an effective treatment option for patient s with vision loss in their second eye resulting from neovascular AMD.展开更多
Objective: To assess the prevalence of recurrence of macular geographic atroph y (GA) of the retinal pigment epithelium (RPE) after macular translocation with 360°retinectomy (MT360) in one institution. Methods: ...Objective: To assess the prevalence of recurrence of macular geographic atroph y (GA) of the retinal pigment epithelium (RPE) after macular translocation with 360°retinectomy (MT360) in one institution. Methods: A retrospective review of all cases of GA that were treated with MT360 in 1 institution. Demographic and c linical data including the duration of preoperative visual loss, preoperative an d postoperative visual acuity, and the prevalence of postoperative foveal RPE at rophy were recorded for these patients, and these data were compared with simila r data from patients who underwent MT360 for neovascular age-related macular degeneration (AMD) as part of the prospective Duke Macula r Translocation Study, Duke University Eye Center, Durham, NC. Results: Four eye s in 4 patients with GA secondary to AMD underwent MT360 and were compared with 63 eyes in 63 patients who underwent MT360 for neovascular AMD as part of the Du ke Macular Translocation Study. The mean duration of preoperative visual loss wa s higher in the GA group (11.3 months) than in the neovascular AMD group (1.7 mo nths) (P=.08). The prevalence of postoperative foveal RPE atrophy was significan tly higher in theGAgroup (n=3; 75.0%) than in the neovascularAMDgroup (n=5; 8.3 %) (P< .01); in the GA group, this corresponded to recurrence of the GA lesions . In contrast, the postoperative RPE atrophy seen in the neovascularAMD group wa s due to postoperative mechanical forces such as laser therapy or RPE tearing. T here was no significant difference in the mean preoperative or postoperative vis ual acuity in either group. Conclusions: Subfoveal RPE atrophy can reoccur follo wing MT360 in eyes with nonneovascularAMDandGA; RPE atrophy similar to this has not been found in a large consecutive series of patients with neovascular AMD af ter MT360. Further research is needed to assess if the potential for visual reco very in eyes with endstage nonneovascular AMD is outweighed by the possibility o f postoperative recurrence of GA.展开更多
文摘Objective To measure the change in vision and visual outcomes at 12 months aft er macular translocation with 360°retinectomy (MT360) and silicone oil tamponad e in patients with bilateral vision loss resulting from subfoveal choroidal neov ascular membranes in age-related macular degeneration (AMD). Design A prospecti ve, interventional, consecutive, noncomparative case series. Participants Sixty -four patients with bilateral vision loss resulting from neovascular AMD. Metho ds Eligible patients had AMD with subfoveal choroidal neovascularization in the operative eye and a maximum of 6 months of central vision loss. Preoperative and 12-month postoperative evaluations included standardized testing of near and d istance acuity and reading speed. Patients underwent MT360 with silicone oil tam ponade, followed 2 months later by extraocular muscle surgery and silicone oil r emoval. Main outcome measures Change in distance acuity, near acuity, and readin g speed at 12 months after MT360 compared with those values before surgery. Resu lts Sixty-one patients were followed up for 12 months. All eyes were translocat ed successfully. Median distance acuity letter score improved from 62 letters (S nellen equivalent of approximately 20/125) before surgery to 69 letters (approxi mately 20/80) by 12 months after surgery (P=0.03). Median near acuity improved f rom 0.70 logarithm of the minimum angle of resolution (logMAR) units (approximat ely 20/100) before surgery to 0.44 logMAR units (approximately 20/55) at 12 mont hs (P < 0.001). Median reading speed improved from 71 words per minute (wpm) bef ore surgery to 105 wpm at 12 months after surgery (P < 0.001). At 12 months, dis tance acuity improved by 1 or more lines in 32 patients (52%). In patients with either preoperative distance or near acuity of 20/80 or better, 74%and 95%of patients, respectively, remained in this range of acuity. In patients with eithe r preoperative distance or near acuity of worse than 20/80, 40%and 48%of patie nts, respectively, improved to 20/80 or better. Postoperative retinal detachment developed in 5 patients (8%), with the macula involved in 2 patients, and all retinas were reattached successfully. Conclusions Macular translocation with 360 °retinectomy with silicone oil tamponade is effective in significantly improvin g visual function in patients with neovascular AMD, as demonstrated by the impro vement in distance and near acuity and reading speed at 12 months after surgery in these patients. Although this is a complex surgical intervention, patients wi th preoperative visual acuity of 20/80 or better at near or distance are highly likely to retain the 20/80 or better acuity at 12 months after surgery. Macular translocation with 360°retinectomy is an effective treatment option for patient s with vision loss in their second eye resulting from neovascular AMD.
文摘Objective: To assess the prevalence of recurrence of macular geographic atroph y (GA) of the retinal pigment epithelium (RPE) after macular translocation with 360°retinectomy (MT360) in one institution. Methods: A retrospective review of all cases of GA that were treated with MT360 in 1 institution. Demographic and c linical data including the duration of preoperative visual loss, preoperative an d postoperative visual acuity, and the prevalence of postoperative foveal RPE at rophy were recorded for these patients, and these data were compared with simila r data from patients who underwent MT360 for neovascular age-related macular degeneration (AMD) as part of the prospective Duke Macula r Translocation Study, Duke University Eye Center, Durham, NC. Results: Four eye s in 4 patients with GA secondary to AMD underwent MT360 and were compared with 63 eyes in 63 patients who underwent MT360 for neovascular AMD as part of the Du ke Macular Translocation Study. The mean duration of preoperative visual loss wa s higher in the GA group (11.3 months) than in the neovascular AMD group (1.7 mo nths) (P=.08). The prevalence of postoperative foveal RPE atrophy was significan tly higher in theGAgroup (n=3; 75.0%) than in the neovascularAMDgroup (n=5; 8.3 %) (P< .01); in the GA group, this corresponded to recurrence of the GA lesions . In contrast, the postoperative RPE atrophy seen in the neovascularAMD group wa s due to postoperative mechanical forces such as laser therapy or RPE tearing. T here was no significant difference in the mean preoperative or postoperative vis ual acuity in either group. Conclusions: Subfoveal RPE atrophy can reoccur follo wing MT360 in eyes with nonneovascularAMDandGA; RPE atrophy similar to this has not been found in a large consecutive series of patients with neovascular AMD af ter MT360. Further research is needed to assess if the potential for visual reco very in eyes with endstage nonneovascular AMD is outweighed by the possibility o f postoperative recurrence of GA.
