http://www.evrs.eu/medias/2006/congress/Recurrent-Choroidal-Neovascularization-after-Macular-Translocation-Surgery-with-360-degree-Peripheral-Retinectomy.swf

WINNER 2006 BAUSCH & LOMB RETINA FELLOWS’ FORUMRESEARCH AWARD

Claxton Baer, MD (Durham, NC), Catherine Bowes Rickman, PhD (Durham, NC), Sunil Srivastava, MD (Atlanta, GA), Goldis Malek, PhD (Durham, NC), Sandra Stinnett, DrPH (Durham, NC), Cynthia A. Toth, MD (Durham, NC)*

PURPOSE:

To evaluate the pattern of age-related macular degeneration (AMD) in the new foveal location after macular translocation surgery with 360 degree peripheral retinectomy (MT360) in one eye of patients with bilateral neovascular AMD.

METHODS:

Noncomparative case series of sixty-four eyes of 64 patients undergoing MT360 for neovascular AMD as part of the Duke Macular Translocation Study with 2 year follow-up data. Clinical data, fundus photos and fluorescein angiograms were reviewed. Main outcome measures included recurrence of CNV, new drusen and geographic atrophy.

RESULTS:

With 56 patients completing follow-up two years after MT360 for neovascular AMD, no patient developed de novo CNV, geographic atrophy or drusen in the new subfoveal RPE bed. By two years, 14 patients (25%) developed recurrent CNV and 13 of these 14 recurrences clearly arose from the old CNV bed with a probable connection to the old CNV bed in the other recurrence. Of the 13 recurrences clearly arising from the old bed, 12 of them had recurrent CNV that involved the superior margin of the bed, the border closest to the repositioned fovea. Most of the 14 recurrences occurred within the first 9 nine months after surgery, and smokers were 5.3 times (95% confidence interval: 1.2 to 24) more likely to develop recurrent CNV over 2 years. Despite treatment, median visual acuity for the 14 eyes with recurrent CNV was 20/200 compared to 20/80 in eyes without recurrence.

CONCLUSION:

The 25% rate of recurrence of CNV at 2 years after MT360 is lower than any other current therapy used to treat neovascular AMD. The recurrence of CNV in the bed of the previous CNV at the border closest to the repositioned fovea suggests that a signaling mechanism from the fovea influences development of CNV in AMD.
* Financial interest disclosed