Macular translocation

Objective: This document describes macular translocation surgery and examines the evidence to answer four key questions about whether the surgery is effective in treating visual loss from age-related macular degeneration, the technique that is most effective, the complications that result from the procedure, and the relationship of the volume of surgery to the number of complications. Methods: A literature search that was conducted in September 1999 retrieved 21 relevant citations, and the reference lists of these articles were consulted for additional citations. Panel members reviewed this information, and a methodologist reviewed and rated all articles as good, fair, or poor in quality. Results: The published literature contains only information from case series, which lack a control group and randomization. They describe a number of approaches, all of which are evolving. Follow-up is limited and visual outcomes vary widely. Serious intraoperative and postoperative complications are frequent, with accompanying risk of visual loss. Surgical morbidity is also an important factor. Conclusions: To date no strong evidence exists 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. Published case series have reported a significant rate of complications. There is no evidence to date to indicate that the complication rate is related to the volume of surgery done. Randomized clinical trials are needed to determine whether macular translocation is a safe and effective treatment for visual loss from age-related macular degeneration. (C) 2000 by the American Academy of Ophthalmology.