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Clinical Sciences |

Long-term Follow-up of Macular Translocation With 360° Retinotomy for Exudative Age-Related Macular Degeneration FREE

Sabine Aisenbrey, MD; Karl Ulrich Bartz-Schmidt, MD; Peter Walter, MD; Ralf Dieter Hilgers, PhD; Helen Ayertey, MD; Peter Szurman, MD; Gabriele Thumann, MD
[+] Author Affiliations

Author Affiliations: Department of Ophthalmology, University of Tuebingen, Tuebingen, Germany (Drs Aisenbrey, Bartz-Schmidt, and Szurman); Department of Ophthalmology, Interdisciplinary Centre for Clinical Research (IZKF) BIOMAT (Drs Walter and Thumann), and Department of Medical Statistics (Dr Hilgers), Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany; and Department of Ophthalmology, University of Cologne, Cologne, Germany (Dr Ayertey).


Arch Ophthalmol. 2007;125(10):1367-1372. doi:10.1001/archopht.125.10.1367.
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Published online

Objective  To assess long-term functional and morphological changes after macular translocation in patients with exudative age-related macular degeneration.

Methods  Evaluation of a noncomparative cohort study of 90 patients with a follow-up of 14 to 79 months (mean, 38.2 months).

Results  Visual acuity increased by 3 or more lines in 15 patients, remained stable in 35 patients, and deteriorated in 40 patients at final examination. Pigment epithelium atrophy extending to the new fovea was detected in 44 patients; in 25 patients this new atrophy was associated with loss of visual function.

Conclusions  Long-term follow-up of macular translocation with 360° retinotomy showed stabilization or improvement in half of the patients. Progressive atrophy of the pigment epithelium represented one major limiting factor of the beneficial effect of the treatment. Macular translocation may be an option for cases of exudative age-related macular degeneration that are not eligible for or do not respond to alternative treatments.

Figures in this Article

Treatment of exudative age-related macular degeneration (AMD) is still controversial and the search for a standard procedure has not been successful. Laser photocoagulation and photodynamic therapy are effective therapeutic options for specific types.1,2 Randomized studies testing the effect of intravitreal and systemic anti–vascular endothelial growth factor therapies are ongoing.3,4 A number of studies have reported results after various surgical treatments of AMD, such as excision of choroidal neovascularization (CNV), transplantation of the pigment epithelium,58 and full macular translocation.915 The only large randomized multicenter trial of its kind, the Submacular Surgery Trial, showed no beneficial effect of CNV extraction on visual function compared with observation.16 The retinal pigment epithelium (RPE) plays a central role in maintaining visual function and its dysfunction may alter the extracellular environment of the photoreceptors, thus contributing to the pathogenesis and treatment failure of late-stage AMD. The purpose of full macular translocation is to move the fovea overlying the damaged or diseased RPE to a location with a healthier-appearing RPE. Several groups have reported recovery of distance and near visual acuity (VA) within the first year in an uncontrolled case series.915 The purpose of this follow-up study was to evaluate long-term functional and morphological changes and to identify independent variables that might predict outcome after full macular translocation for neovascular AMD.

Between 1997 and 1999, 90 eyes of 90 patients with exudative AMD underwent a macular translocation operation in a prospective consecutive case series as published previously.13 All patients were contacted and scheduled for a long-term follow-up visit. General and ophthalmologic medical history was obtained from all patients since their last visit. Biomicroscopy of the anterior segment, ophthalmoscopy, intraocular pressure measurement, fundus photography, and fluorescein angiography were performed on all patients. Best-corrected distance VA was measured with the use of the Early Treatment Diabetic Retinopathy charts. Primary efficacy outcome was change in VA of the study eye at final examination compared with baseline. The secondary aim was to define factors influencing functional outcome. Data are described by means, SDs, and frequencies, as well as corresponding 95% confidence intervals. Univariate and multivariate analysis of covariance models were fitted to VA observation at final examination. Detailed comparisons were performed with 95% confidence intervals corresponding to the least significant difference t test. Effects with P < .05 were considered significant.

Mean follow-up was 38.2 months (range, 14-79). At the end of the observation period, 25 patients (27.8%) had died. Postoperatively, 63 patients (70%) were followed up for 2 years or longer, 52 patients (57.8%) for 3 years or longer, 38 patients (42.2%) for 4 years or longer, and 25 patients (27.8%) for 5 years or longer.

FUNCTIONAL OUTCOME

At 12 months after full macular translocation, mean VA had remained at 1.07 logarithm of the minimum angle of resolution (logMAR) units (20/200).13 Final VA ranged from 3.0 logMAR units (no light perception) to 0.3 logMAR units (20/40), with a mean of 1.26 logMAR units (20/300). At 1 year, an increase in VA of 3 or more lines was observed in 24 patients; VA was stable in 37 patients and deteriorated in 29 patients. At final examination, VA had increased in 15 patients, was stable in 35 patients, and had deteriorated in 40 patients (Table 1). Compared with a mean logMAR value of 1.00 (SD, 0.36) at baseline, mean logMAR value at 12 months was 1.07 (SD, 0.43) and 1.26 (SD, 0.53) at final examination, thus resulting in a mean change of 0.26 logMAR units (SD, 0.56) during the time period of about 3 years (Table 2). Figure 1 shows the survival curve with survival defined as not having lost 3 lines. At 12 and 36 months, 84% and 75% of patients, respectively, had not experienced a loss of 3 lines. Change in VA was influenced by the development of secondary RPE atrophy, including that of the new fovea. Mean change in VA in patients with central RPE atrophy was 0.37 logMAR units (SD, 0.60) compared with a change in VA of 0.0 logMAR units (SD, 0.36) in patients without RPE atrophy, a statistically significant difference (F1.70 = 8.8; P = .004).

Place holder to copy figure label and caption
Figure 1.

Kaplan-Meier plot, with survival defined as not having lost 3 or more lines (84% of patients at 12 months and 69% of patients at 36 months).

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Table Graphic Jump LocationTable 1. Frequency Distribution of Change in Visual Acuity at 12 Months and Final Examination From Baseline
Table Graphic Jump LocationTable 2. Change in Visual Acuity at 12 Months and Final Examination From Baseline

Univariate analysis showed that VA differences tended to be associated with type of CNV (F2.87 = 4.88, P = .001), retinal complications (F1.88 = 2.02, P = .16), and revisional operation (F 1.88 = 2.05, P = .16). No association with the surgeon (F2.87 = 0.14, P = .87) or patient age (F1.88 = 1.97, P = .16) was observed. Multivariate analysis of covariance gave a uniform assessment of the effects, indicating that VA differences were associated with baseline VA (F1.83 = 9.79, P = .002) but not with length of follow-up (F 1.83 = 0.96, P = .33) (Figure 2), type of CNV (F2.83 = 0.61, P = .54) (Figure 2), or revisional operation (F1.83 = 2.35, P = .13).

Place holder to copy figure label and caption
Figure 2.

Scatterplot of all patients. Change of patients' final visual acuity (VA) as a function of follow-up time does not show better outcomes at shorter follow-up intervals or worse outcomes at longer intervals. Regression analysis of the change in VA as a function of choroidal neovascularization (CNV) type did not show any linear trend. logMAR indicates logarithm of the minimum angle of resolution.

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A scatterplot of all patients (Figure 2) shows the distribution of change of patients' final VA as a function of the follow-up time. The distribution of the patients does not show better outcome at the shorter follow-up intervals or worse outcome at the longer intervals. Regression analysis of the change in VA as a function of CNV type did not show any linear trend.

ANGIOGRAPHIC OUTCOMES AND COMPLICATIONS

Complications immediately following the operation and those occurring within the first year after the operation have been described previously.13 Between the 12-month and final examinations, 4 patients showed retinal complications with proliferative vitreoretinopathy retinal detachment that required additional surgical treatment. Late recurrence was seen in only 1 patient after the 1-year follow-up examination (at 51 months postoperatively); the patient was then treated by photocoagulation. Cystoid macular edema was diagnosed in 7 patients at final examination (in 3 eyes, cystoid macular edema persisted after 12 months; 4 eyes did not show cystoid macular edema at 12 months). At the final examination, excluding patients with detected early or late recurrence of CNV (Figure 3), secondary RPE and choroid atrophy extending to the new fovea was observed in 61% of patients (Figure 4). In 25 patients, foveal atrophy was associated with loss of 15 or more letters, indicating that secondary atrophy was 1 major factor in determining visual outcome after full macular translocation.

Place holder to copy figure label and caption
Figure 3.

A, B, and C, Preoperative fluorescein angiograms (early, middle, and late phases, respectively) of the left eye of a 63-year-old male patient demonstrating classic subfoveal choroidal neovascularization (visual acuity, 20/80). D, Fundus photograph. E and F, Angiograms at 64 months (visual acuity, 20/40). Patient had had surgical excision of recurrent choroidal neovascularization 6 months after full macular translocation.

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Place holder to copy figure label and caption
Figure 4.

A, Preoperative red-free image. B and C, Fluorescein angiograms (early and late phases, respectively) of the right eye of a 71-year-old male patient demonstrating occult subfoveal choroidal neovascularization (visual acuity, 20/125). D, Red-free image at 12 months. E and F, Fluorescein angiograms at 12 months after full macular translocation (visual acuity, 20/400). G, Red-free image at 75 months. H and I, Fluorescein angiogram at 75 months (visual acuity, 20/320) (note the retinal pigment epithelium atrophy extending toward the new fovea).

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In this article, we present long-term results of a consecutive series of 90 patients who underwent full macular translocation for exudative AMD with a follow-up of about 3 years. At final examination, 54% of patients showed improved or stable VA and 46% had lost 3 or more lines. Our early enthusiasm about this therapy approach, which allowed for improvement of VA in some patients supported by encouraging results reported at 1 year after full macular translocation,915 has been fading before the background of long-term results. Macular edema, proliferative vitreoretinopathy, and recurrence have been identified as key factors for limitation of postoperative VA. The observation of progressive RPE atrophy after full macular translocation in patients without apparent recurrent CNV as an additional major factor for loss of VA over time may contribute to long-term prognosis and patient selection. In our study, RPE atrophy appeared late after an operation in eyes without sign for recurrence in angiography and did not include scarring at margins of the lesion as seen after treated or spontaneous transformation of recurrent CNV. Angiographically, these changes were new and different from the original pathology. However, these findings reflect the observations described in patients with geographic atrophy after full macular translocation, in which these changes could be defined as recurrence of the disease at a new location.17,18 One possible explanation could be that operations in these patients were performed at a stage of the disease when RPE cells and the Bruch membrane under the prospective fovea and the photoreceptors of the original fovea had already been severely damaged and lost the capacity for recovery. Timing of intervention represents a major issue in all therapeutic approaches in the treatment of AMD. Even if involution of the neovascular complex is achieved, significant improvement in VA after treatment, such as photodynamic or intravitreal therapy, may be limited by impaired choroidal perfusion and/or persistent fibrotic lesions remaining beneath the fovea in late-stage AMD.

Complications from a complex operation such as full macular translocation affect functional outcome. Retinal detachment and proliferative vitreoretinopathy are of great concern. In our study, 19% of patients had retinal detachment with proliferative vitreoretinopathy that developed within the first year. An additional 4 patients (4%) had retinal detachment with proliferative vitreoretinopathy in later follow-up. The incidence of retinal detachment and/or proliferative vitreoretinopathy ranges from 17% to 25% in published studies.915 Cystoid macular edema represents one of the most frequent complications, with rates of up to 70%.915 Extent and time of appearance of cystoid macular edema may represent an early sign for struggling RPE at the location of the new fovea. At the final examination in our series, 7 patients showed cystoid macular edema (8%). Recurrent CNV originating from the RPE bed of the removed CNV has been observed in 8% to 21% of patients.915 Reported recurrence rate may be dependent on methods chosen by authors, as sensitivity is critical to detect recurrence and to differentiate it from RPE alteration. Between the 12-month examination and the last follow-up visit, we observed new recurrent CNV, a vascular net with progressive leakage in the late phase, in only 1 patient. Choroidal neovascularization did not recur in any of the 3 patients who had been treated for CNV recurrence during the first 12 months, suggesting that the highest proliferative activity and thus risk for recurrent CNV occurs within the first year after full macular translocation.

The goal of full macular translocation is vision improvement, but there is no evidence to suggest that it does so consistently. Improvement in some patients seems to be offset by deterioration in others. Thus, case selection may be the key to predict outcome and to define the role of full macular translocation.19 However, data on predictive factors are inconsistent. Mruthyunjaya and coworkers15 reported that better levels of preoperative visual function were predictive of better levels 12 months after full macular translocation. In our series, the preoperative level of VA did not prove to be a statistically significant factor for change in VA postoperatively. Similar findings have been reported by Wong et al.19 Lesion size and lesion composition also have been proposed to impact visual outcome. At 12 months, we saw better outcome in patients with hemorrhagic AMD or classic CNV, whereas Wong et al19 reported poorer functional outcome for patients with minimally classic CNV compared with patients with predominantly classic CNV.19 In our long-term results, CNV type had no influence on visual outcome. Comparison of results of published studies is limited by difference in follow-up time, inclusion criteria, and surgical and examination techniques. However, there seems to be agreement that early treatment is the key factor to possibly achieve improvement of VA. Compared with alternative approaches of restoring macular RPE function, including membrane extraction alone and membrane extraction combined with iris pigment epithelium transplantation, long-term results after full macular translocation are clearly superior.58 Retinal pigment epithelium transplantation combined with membrane extraction showed improvement of 3 to 8 lines in 38.4% of the cases 12 months after the operation.6 These results are similar to those we have obtained after full macular translocation. However, long-term results of RPE transplantation remain to be determined. Given that ours was a single-center study on a small number of patients (coupled with the large-size lesions [median, 2.8 disc diameters] and variable composition of the subfoveal lesion limits), significance of results hinders clinically significant comparison with alternative surgical and nonsurgical interventions in the treatment of AMD.

Even with other treatment options available, full macular translocation may still be considered for selected cases of exudative AMD, such as those who are not eligible or do not respond to alternative treatments. Case selection and decision should carefully consider the risk of early and late systemic and ocular complications.

Correspondence: Sabine Aisenbrey, MD, Department of Ophthalmology, University of Tuebingen, Schleichstrasse 12-16, 72076 Tuebingen, Germany (sabine.aisenbrey@med.uni-tuebingen.de).

Submitted for Publication: September 30, 2006; final revision received April 12, 2007; accepted April 14, 2007.

Financial Disclosure: None reported.

Funding/Support: This study was supported by a grant from the Interdisciplinary Centre for Clinical Research (IZKF) BIOMAT/medical faculty at the Rheinisch-Westfälische Hochschule, Aachen, Germany.

Macular Photocoagulation Study Group, Visual outcome after laser photocoagulation for subfoveal choroidal neovascularization secondary to age-related macular degeneration. Arch Ophthalmol 1994;112 (4) 480- 488
PubMed Link to Article
Treatment of Age-Related Macular Degeneration With Photodynamic Therapy (TAP) Study Group, Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials, TAP report 1. Arch Ophthalmol 1999;117 (10) 1329- 1345
PubMed Link to Article
VEGF Inhibition Study in Ocular Neovascularization (V.I.S.I.O.N.) Clinical Trial Group,D'Amico  DJMasonson  HNPatel  M  et al.  Pegaptanib sodium for neovascular age-related macular degeneration: two-year safety results of the two prospective, multicenter, controlled clinical trials. Ophthalmology 2006;113 (6) 992- 1001.e6
PubMed Link to Article
Heier  JSAntoszyk  ANPavan  PR  et al.  Ranibizumab for treatment of neovascular age-related macular degeneration: a phase I/II multicenter, controlled, multidose study. Ophthalmology 2006;113 (4) 642.el
PubMed Link to Article
Aisenbrey  SLafaut  BASzurman  P  et al.  Iris pigment epithelial translocation in the treatment of exudative macular degeneration: a 3-year follow-up. Arch Ophthalmol 2006;124 (2) 183- 188
PubMed Link to Article
Binder  SKrebs  IHilgers  RD  et al.  Outcome of transplantation of autologous retinal pigment epithelium in age-related macular degeneration: a prospective trial. Invest Ophthalmol Vis Sci 2004;45 (11) 4151- 4160
PubMed Link to Article
MacLaren  REBird  ACSathia  PJAylward  GW Long-term results of submacular surgery combined with macular translocation of the retinal pigment epithelium in neovascular age-related macular degeneration. Ophthalmology 2005;112 (12) 2081- 2087
PubMed Link to Article
Joussen  AMHeussen  FMJoeres  S  et al.  Autologous translocation of the choroid and retinal pigment epithelium in age-related macular degeneration. Am J Ophthalmol 2006;142 (1) 17- 30
PubMed Link to Article
Ninomiya  YLewis  JMHasegawa  TTano  Y Retinotomy and foveal translocation for surgical management of subfoveal choroidal neovascular membranes. Am J Ophthalmol 1996;122 (5) 613- 621
PubMed
Eckardt  CEckardt  UConrad  HJ Macular rotation with and without counter-rotation of the globe in patients with age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 1999;237 (4) 313- 325
PubMed Link to Article
Lewis  HKaiser  PLewis  SEstafanous  M Macular translocation for subfoveal choroidal neovascularization in age-related macular degeneration: a prospective study. Am J Ophthalmol 1999;128 (2) 135- 146
PubMed Link to Article
Akduman  LKaravellas  MMacDonald  COlk  JFreeman  W Macular translocation with retinotomy and retinal rotation for exudative age-related macular degeneration. Retina 1999;19 (5) 418- 423
PubMed Link to Article
Aisenbrey  SLafaut  BASzurman  P  et al.  Macular translocation with 360° retinotomy for exudative age-related macular degeneration. Arch Ophthalmol 2002;120 (4) 451- 459
PubMed Link to Article
Abdel-Meguid  ALappas  AHartmann  K  et al.  One year follow up of macular translocation with 360 degree retinotomy in patients with age-related macular degeneration. Br J Ophthalmol 2003;87 (5) 615- 621
PubMed Link to Article
Mruthyunjaya  PStinnett  SSToth  CA Change in visual function after macular translocation with 360° retinectomy for neovascular age-related macular degeneration. Ophthalmology 2004;111 (9) 1715- 1724
PubMed Link to Article
Bressler  NMBressler  SBChilds  AL  et al. Submacular Surgery Trials (SST) Research Group, Surgery for hemorrhagic choroidal neovascular lesions of age-related macular degeneration: ophthalmic findings, SST report No. 13. Ophthalmology 2004;111 (11) 1993- 2006
PubMed Link to Article
Cahill  MTMruthyunjaya  PBowes Rickman  CToth  CA Recurrence of retinal pigment epithelial changes after macular translocation with 360° peripheral retinectomy for geographic atrophy. Arch Ophthalmol 2005;123 (7) 935- 938
PubMed Link to Article
Khurana  RNFujii  GYWalsh  ACHumayun  MSde Juan  ESadda  SR Rapid recurrence of geographic atrophy after full macular translocation for nonexudative age-related macular degeneration. Ophthalmology 2005;112 (9) 1586- 1591
PubMed Link to Article
Wong  DStanga  PBriggs  M  et al.  Case selection in macular relocation surgery for age-related macular degeneration. Br J Ophthalmol 2004;88 (2) 186- 190
PubMed Link to Article

Figures

Place holder to copy figure label and caption
Figure 1.

Kaplan-Meier plot, with survival defined as not having lost 3 or more lines (84% of patients at 12 months and 69% of patients at 36 months).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Scatterplot of all patients. Change of patients' final visual acuity (VA) as a function of follow-up time does not show better outcomes at shorter follow-up intervals or worse outcomes at longer intervals. Regression analysis of the change in VA as a function of choroidal neovascularization (CNV) type did not show any linear trend. logMAR indicates logarithm of the minimum angle of resolution.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

A, B, and C, Preoperative fluorescein angiograms (early, middle, and late phases, respectively) of the left eye of a 63-year-old male patient demonstrating classic subfoveal choroidal neovascularization (visual acuity, 20/80). D, Fundus photograph. E and F, Angiograms at 64 months (visual acuity, 20/40). Patient had had surgical excision of recurrent choroidal neovascularization 6 months after full macular translocation.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.

A, Preoperative red-free image. B and C, Fluorescein angiograms (early and late phases, respectively) of the right eye of a 71-year-old male patient demonstrating occult subfoveal choroidal neovascularization (visual acuity, 20/125). D, Red-free image at 12 months. E and F, Fluorescein angiograms at 12 months after full macular translocation (visual acuity, 20/400). G, Red-free image at 75 months. H and I, Fluorescein angiogram at 75 months (visual acuity, 20/320) (note the retinal pigment epithelium atrophy extending toward the new fovea).

Graphic Jump Location

Tables

Table Graphic Jump LocationTable 1. Frequency Distribution of Change in Visual Acuity at 12 Months and Final Examination From Baseline
Table Graphic Jump LocationTable 2. Change in Visual Acuity at 12 Months and Final Examination From Baseline

References

Macular Photocoagulation Study Group, Visual outcome after laser photocoagulation for subfoveal choroidal neovascularization secondary to age-related macular degeneration. Arch Ophthalmol 1994;112 (4) 480- 488
PubMed Link to Article
Treatment of Age-Related Macular Degeneration With Photodynamic Therapy (TAP) Study Group, Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials, TAP report 1. Arch Ophthalmol 1999;117 (10) 1329- 1345
PubMed Link to Article
VEGF Inhibition Study in Ocular Neovascularization (V.I.S.I.O.N.) Clinical Trial Group,D'Amico  DJMasonson  HNPatel  M  et al.  Pegaptanib sodium for neovascular age-related macular degeneration: two-year safety results of the two prospective, multicenter, controlled clinical trials. Ophthalmology 2006;113 (6) 992- 1001.e6
PubMed Link to Article
Heier  JSAntoszyk  ANPavan  PR  et al.  Ranibizumab for treatment of neovascular age-related macular degeneration: a phase I/II multicenter, controlled, multidose study. Ophthalmology 2006;113 (4) 642.el
PubMed Link to Article
Aisenbrey  SLafaut  BASzurman  P  et al.  Iris pigment epithelial translocation in the treatment of exudative macular degeneration: a 3-year follow-up. Arch Ophthalmol 2006;124 (2) 183- 188
PubMed Link to Article
Binder  SKrebs  IHilgers  RD  et al.  Outcome of transplantation of autologous retinal pigment epithelium in age-related macular degeneration: a prospective trial. Invest Ophthalmol Vis Sci 2004;45 (11) 4151- 4160
PubMed Link to Article
MacLaren  REBird  ACSathia  PJAylward  GW Long-term results of submacular surgery combined with macular translocation of the retinal pigment epithelium in neovascular age-related macular degeneration. Ophthalmology 2005;112 (12) 2081- 2087
PubMed Link to Article
Joussen  AMHeussen  FMJoeres  S  et al.  Autologous translocation of the choroid and retinal pigment epithelium in age-related macular degeneration. Am J Ophthalmol 2006;142 (1) 17- 30
PubMed Link to Article
Ninomiya  YLewis  JMHasegawa  TTano  Y Retinotomy and foveal translocation for surgical management of subfoveal choroidal neovascular membranes. Am J Ophthalmol 1996;122 (5) 613- 621
PubMed
Eckardt  CEckardt  UConrad  HJ Macular rotation with and without counter-rotation of the globe in patients with age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 1999;237 (4) 313- 325
PubMed Link to Article
Lewis  HKaiser  PLewis  SEstafanous  M Macular translocation for subfoveal choroidal neovascularization in age-related macular degeneration: a prospective study. Am J Ophthalmol 1999;128 (2) 135- 146
PubMed Link to Article
Akduman  LKaravellas  MMacDonald  COlk  JFreeman  W Macular translocation with retinotomy and retinal rotation for exudative age-related macular degeneration. Retina 1999;19 (5) 418- 423
PubMed Link to Article
Aisenbrey  SLafaut  BASzurman  P  et al.  Macular translocation with 360° retinotomy for exudative age-related macular degeneration. Arch Ophthalmol 2002;120 (4) 451- 459
PubMed Link to Article
Abdel-Meguid  ALappas  AHartmann  K  et al.  One year follow up of macular translocation with 360 degree retinotomy in patients with age-related macular degeneration. Br J Ophthalmol 2003;87 (5) 615- 621
PubMed Link to Article
Mruthyunjaya  PStinnett  SSToth  CA Change in visual function after macular translocation with 360° retinectomy for neovascular age-related macular degeneration. Ophthalmology 2004;111 (9) 1715- 1724
PubMed Link to Article
Bressler  NMBressler  SBChilds  AL  et al. Submacular Surgery Trials (SST) Research Group, Surgery for hemorrhagic choroidal neovascular lesions of age-related macular degeneration: ophthalmic findings, SST report No. 13. Ophthalmology 2004;111 (11) 1993- 2006
PubMed Link to Article
Cahill  MTMruthyunjaya  PBowes Rickman  CToth  CA Recurrence of retinal pigment epithelial changes after macular translocation with 360° peripheral retinectomy for geographic atrophy. Arch Ophthalmol 2005;123 (7) 935- 938
PubMed Link to Article
Khurana  RNFujii  GYWalsh  ACHumayun  MSde Juan  ESadda  SR Rapid recurrence of geographic atrophy after full macular translocation for nonexudative age-related macular degeneration. Ophthalmology 2005;112 (9) 1586- 1591
PubMed Link to Article
Wong  DStanga  PBriggs  M  et al.  Case selection in macular relocation surgery for age-related macular degeneration. Br J Ophthalmol 2004;88 (2) 186- 190
PubMed Link to Article

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