BMJ  2003;326:1459 (28 June), doi:10.1136/bmj.326.7404.1459

Letter

Age related macular degeneration

Macular relocation surgery was not taken into account

EDITOR—Chopdar et al searched Medline for literature but seem to have neglected over 75 publications on macular relocation surgery for age related and myopic macular degeneration.¹ They concluded that no current treatment will restore vision that has already been lost.

The excitement over macular relocation is precisely because it is capable of improving vision in some patients despite moderate and severe visual loss.² Lai et al reported that at six months, the reading vision was significantly improved, from 0.54 to 0.40 LogMAR units in a consecutive series of 15 patients (P=0.02).³ Pertile and Claes recently reported that in a consecutive series of 50 cases with a median follow up of 21 months 66% improved (2 or more lines), 28% remained stable (±1 line) and only 6% deteriorated (2 or more lines).⁴

Macular relocation surgery is complex and prone to complications including proliferative vitreoretinopathy. As experience of this surgery increases it seems, however, that the complication rate (and surgical time) is falling and that the success rate is rising.⁵ Recent work showing that adjuvant treatments can be used to prevent proliferative vitreoretinopathy have also given rise to optimism. Moreover, macular relocation surgery has the potential to treat geographic atrophy (dry age related macular degeneration) and advanced disease (including subfoveal haemorrhage), which will not be amenable to any anti-angiogenic strategy.

Germany's research council is funding an international prospective randomised controlled trial (macular relocation for age related neovascular disease, MARAN) for patients with occult subfoveal choroidal neovascular membrane. Other non-comparative pilot studies are being undertaken to identify which subgroups of patients are most likely to benefit from macular relocation surgery and to help in planning other prospective randomised trials.

Although semiconductor chip technology and the "electronic eye" have captured the imagination of the public, the "bionic eye" is perhaps much further away from benefiting patients than is macular relocation surgery.

St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP

Vitreoretinal Surgical Unit david.charteris{at}moorfields.nhs.uk

Medical and Surgical Retinal Units, Moorfields Eye Hospital, London EC1V 2PD

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Competing interests: None declared.

References

1. Chopdar A, Chakravarthy U, Verma D. Age related macular degeneration. BMJ 2003;326: 485-8. (1 March.)[Free Full Text]
2. Wong D, Harding S, Grierson I. Foveal translocation with secondary confluent laser for subfoveal CNV in AMD: 12 month follow up. Br J Ophthalmol 2000;84: 670-1.[Medline]
3. Lai JC, Lapolice DJ, Stinnett SS, Meyer CH, Arieu LM, Keller MA, et al. Visual outcomes following macular translocation with 360-degree peripheral retinectomy. Arch Ophthalmol 2002;120: 1317-24.[Abstract/Free Full Text]
4. Pertile G, Claes C. Macular translocation with 360 degree retinotomy for management of age-related macular degeneration with subfoveal choroidal neovascularization. Am J Ophthalmol 2002;134: 560-5.[CrossRef][ISI][Medline]
5. Toth CA, Freedman SF. Macular translocation with 360-degree peripheral retinectomy impact of technique and surgical experience on visual outcomes. Retina 2001;21: 293-303.[CrossRef][ISI][Medline]

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Relevant Article

Age related macular degeneration

Amresh Chopdar, Usha Chakravarthy, and Dinesh Verma
BMJ 2003 326: 485-488. [Extract] [Full Text] [PDF]