November 25, 2003

Macular Translocation

Posted in: Therapies, Treatments, and Procedures

by Dan Roberts
Originally published July 2000 (Updated November 2003)

Simply put, macular translocation is an experimental surgical procedure which involves detachment of the retina and relocation of it to a healthier spot in the eye. It has been described as “three to four hours of operating on something the size of a postage stamp and the consistency of wet tissue.”

The surgery is tedious, and it is not recommended for every MD patient. It is best performed on people in the early stage of the disease, and it is only meant to treat the wet form of MD, in which leaking blood vessels have formed beneath the retina.

The surgeon pinches the sclera, the white, outer part of the eye. Then he puts sutures into the side wall of the eye to keep it pinched, shortening its length and buckling the retina. He then injects a salty solution into the eye under the retina, causing it to “blister” up enough so he can move it, without detaching it, no more than 0.3 to 0.4 millimeters. A gas bubble is then injected into the eye to hold the retina in its new place until it heals. Once healing has taken place, it is then possible to treat the previously-covered blood vessels without harming the translocated retina.

Various results have been reported, from achieving a return to 20/20 vision to no improvement at all, and there have been some cases where vision has worsened. Macular translocation is not a cure for macular degeneration, but it is showing some promise as an effective alternative to laser surgery as a treatment for the disease.

In May 2000, the American Academy of Ophthalmology published a report on their examination of the evidence to answer the following questions about macular translocation surgery (Ophthalmology 2000 May;107(5):1015-8). Those questions were:

  1. Is it effective in treating visual loss from age-related macular degeneration;
  2. What technique is most effective;
  3. What complications result from the procedure; and
  4. What is the relationship of the volume of surgery to the number of complications?

The group’s conclusions were:

  1. No strong evidence exists to date with which to answer questions about the effectiveness of macular translocation surgery in treating visual loss from age-related macular degeneration or about the most effective technique;
  2. Published case series have reported a significant rate of complications;
  3. There is no evidence to date to indicate that the complication rate is related to the volume of surgery done; and
  4. Randomized clinical trials are needed to determine whether macular translocation is a safe and effective treatment for visual loss from age-related macular degeneration.

Researchers at Duke Eye Center in Durham, North Carolina, reported in the November 1, 2003 issue of the American Journal of Ophthalmology that they have had success with a refinement of macular translocation surgery. They call their new technique “macular translocation surgery with 360 degree peripheral retinectomy” (MT360). It is a two-stage procedure. The first stage involves rotating the retina to move the macula away from the abnormally growing blood vessels. The second stage corrects the resulting tilted visual field by rotating the eye itself.

The best candidates for MT360 are patients who have central vision loss in one eye and recent vision loss in the other. Risks include retinal detachment, bleeding, double vision, and residual tilting of vision. All of these risks can be corrected either surgically or with special glasses.

Until recently, MT360 had not been used on patients who had previously undergone treatment for macular disease. Now Duke researchers are reporting success even in people who have experienced scarring and further vision loss after treatment by other means. The research teams are led by Cynthia Toth, M.D. and Sharon Freedman, M.D. The MT360 technique was pioneered by Robert Machemer, M.D., now retired.

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