Macular translocation is a surgical treatment where the retina, the area on the eye's back wall that detects objects/images, is detached from diseased tissue and moved to a healthier retinal pigment epithelium (RPE). The primary purpose of the procedure is to reposition the macula, the light-sensitive spot at the center of the retina, to improve the patient's vision. It can also be used to seal or remove leaking blood vessels in the eye.
The technique is often used to treat patients with choroidal neovascularization (CNV) due to age macular degeneration (AMD), i.e., advanced AMD. It's also useful in other types of subfoveal CNVs. The procedure is considered after Anti-VEGF (vascular endothelial growth factor) treatment, which is the primary therapy for subfoveal neovascular disease. It's usually preferred in patients with bilateral loss of central vision resulting from postoperative torsional diplopia. It can also be used in:
- Retinal pigment epithelial tears
- Eyes with extensive subretinal fibrosis
- Nonresponders to anti-VEGF treatment
- Submacular disorders that are not VEGF-driven
- Some instances of extensive subretinal hemorrhage
Also Known As
- Retinal rotation
- Machemer technique
- Full macular translocation
- Macular translocation surgery with 360° peripheral retinectomy
Before the Procedure
The eye surgeon will assess the patient's complete medical and surgical history and perform a thorough retinal examination. An outer retinal evaluation with scleral depression is essential to detect fringe pathologies, such as outer holes and chorioretinal scars, that can cause complications during the procedure.
S/he will also determine the lens status of the patient. Patients without a lens (phakic) usually undergo phacoemulsification and lens placement before or during the macular translocation surgery. If a patient has an intraocular lens (IOL), s/he will establish the type of implant and condition of the lens capsule. The surgeon will be interested in patients with a history of strabismus or vitreoretinal surgeries. A longer duration of vision impairment increases the risk of scarring or atrophy of the neurosensory retina, with irreversible damage.
The patient will undergo a complete eye examination, including:
- Optical coherence tomography
- Fundus autofluorescence
- Fluorescein angiography
- Fundus photography
- Fixation test
The eye exam is useful in identifying poor candidates for the treatment. This includes patients with:
- CNV in the area of intended translocation
- Extensive neurosensory retinal atrophy
- Severe macular chorioretinal scarring
- Retinal angiomatous lesions
- Chorioretinal anastomosis
- Widespread RPE atrophy
- Retinal vascular disease
The procedure is undertaken in an operating room under general or local anesthesia. The surgeon will numb, clean, and place a lid speculum on the patient's eye to keep it open. S/he will cut the white part of the eye, the sclera, and remove the jelly substance (vitreous) in the rear eye chamber with a microscopic cutting device. S/he will then induce retinal detachment with subretinal fluid injection, move the fovea away from the CNV and relocate it over healthy tissue. Where the patient needs a new lens, cataract extraction and IOL placement are conducted together with the macular translocation.
Risks & Complications
The most severe risks associated with the surgery are retinal detachment and proliferative vitreoretinopathy. Other risks include:
- Macular fold
- Macular hole
- Scleral perforation
- Cataract formation
- Subretinal hemorrhage
The procedure's side effects may include soreness, redness, discomfort, and hazy vision, in the affected eye.
Complications may include:
- Double vision
- Recurrence of the CNV
- Corneal decompensation
- Neovascularization of iris
After Care & Recovery
The surgeon will prescribe medication including antibiotics and give aftercare instructions. The patient must apply the medicine throughout the day for the given period, to control swelling and prevent infection. The patient must also follow the positioning guideline, which may include laying face-down or alternating the side-to-side position to lower the chances of developing complications. The doctor will want to see the patient the day after the operation to assess the patient's status and schedule follow-up visits. The patient may have to wear an eye patch for a day or two to protect the eye.
During the recovery period, the patient will need to prevent water from getting into the eye and avoid activities that increase pressure in the eye such as reading, exercise, driving, air travel, etc. They should also desist from tasks that may expose the eye to grime, dust, or other contaminants that can lead to infection. The patient may be provided with a special pair of sunglasses to protect the eyes from bright light during the recovery period.
The treatment can be useful, particularly in patients with advanced AMD and disease refractory to anti-VEGF therapy. Results showed that the impaired macula function could recover on the new RPE after the relocation for at least five years. However, the technique is hardly used nowadays because of its potential risks and complications.