Macular translocation for neovascular age-related macular degeneration
Editorial Group: Cochrane Eyes and Vision Group
Published Online: 8 OCT 2008
Assessed as up-to-date: 20 JUL 2008
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Eandi CM, Giansanti F, Virgili G. Macular translocation for neovascular age-related macular degeneration. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD006928. DOI: 10.1002/14651858.CD006928.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 8 OCT 2008
Macular translocation has been proposed by vitreoretinal surgeons to displace the neuroretinal tissue onto healthy retinal pigment epithelium and choroid when the macula has been invaded by subretinal neovascularisation.
This review aims at assessing the effectiveness of macular translocation for preserving or improving vision in patients with neovascular age-related macular degeneration (AMD).
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE and Caribbean Literature on Health Sciences (LILACS). There were no language or date restrictions in the search for trials.The electronic databases were last searched on 21 July 2008.
We included randomised or quasi randomised controlled trials comparing macular translocation with any other treatment or observation.
Data collection and analysis
Two authors independently extracted the data. The risk ratio (RR) of visual loss and visual gain was estimated at one year after treatment.
Only one small unblinded study on 50 people compared full macular translocation with photodynamic therapy (PDT) in AMD patients with predominantly classic subfoveal choroidal neovascularisation (CNV). At the last examination, performed in most of the cases after one year, there was no difference in the rate of visual loss of 3 or more lines (translocation versus PDT: RR 0.56, 95% confidence interval (CI) 0.22 to 1.43), as well as in the mean change of contrast sensitivity (1 letter favouring translocation; 95% CI -3.51 to 5.51) and the rate of recurrence of CNV (translocation versus PDT: RR 1.56, 95% CI 0.83 to 2.91). Other outcomes significantly favoured translocation, such as the gain of 3 or more ETDRS lines (RR 21, 95% CI 1.30 to 340.02), the mean change of visual acuity (mean difference (MD) 14.60, 95% CI 5.39 to 23.81) and the mean change of near visual acuity score (MD 17.80, 95% CI 3.98 to 31.62) which is obtained with an algorithm. Serious complications reported after macular translocation were retinal detachment in 6/25 patients and diplopia requiring prismatic correction in 5/25 patients.
There is insufficient evidence from randomised controlled trials on the effectiveness of macular translocation, which is also not free of important risks. Furthermore, this technique is difficult to perform and a long surgical training is required. Future studies might include patients with small neovascular lesions that failed to respond to current pharmacological therapies and are willing to accept the risks associated with surgery to try to improve visual acuity.
Plain language summary
Macular translocation for age-related macular degeneration
It is unclear if macular translocation can improve vision in patients with wet AMD, the form of age-related macular degeneration (AMD) caused by the abnormal growth of new blood vessels in the region of the central retina called macula. Age-related macular degeneration leads to the development of a blind spot in the centre of the visual field and is the most common cause of legal blindness among the elderly in the western world. Macular translocation is a surgical procedure that involves the detachment of the retina which includes the macula into a less-damaged area. Some ophthalmologists have suggested that this surgery can help patients improve vision. We found a small study suggesting that vision might improve, but severe complications can arise during the process of retinal displacement. Thus, macular translocation might not be considered for most patients with wet AMD given the treatment options already available.
我們檢索考科藍圖書館的the Cochrane Central Register of Controlled Trials (CENTRAL)，MEDLINE，EMBASE及Caribbean Literature on Health Sciences (LILACS)。檢索試驗的條件不限制語言或日期。電子資料庫最近一次的更新是在2008年7月21日。
兩名作者分別摘錄資料。估計治療後一年視力喪失與獲得的相對風險(risk ratio (RR))。
只有一篇小型非盲目的研究，包含50人，比較全黃斑部轉位術與光動力療法(photodynamic therapy (PDT))治療主要為典型的中心窩下脈絡膜新血管生成(choroidal neovascularisation (CNV))的AMD患者。最近一次的評估發現，一年後大部分的病例其3行或以上視力喪失的比率(轉位術對照PDT：RR為0.56，95% confidence interval (CI)為0.22至1.43)，以及對比敏感度的平均改變量(一個字母的結果偏好轉位術；95% CI為−3.51至5.51)及CNV復發的比率(轉位術對照PDT：RR為1.56，95% CI為0.83至2.91)沒有差異。其他的結果顯著偏好轉位術，如獲得3行或以上的ETDRS(RR為21，95% CI為1.30至340.02)，視力的平均改變量(平均差(mean difference (MD))為14.60，95% CI為5.39至23.81)及由算數取得之近距離視力評分的改變量(MD為17.80，95% CI為3.98至31.62)。黃斑部轉位術後的嚴重併發症有6/25的患者視網膜剝離且5/25的患者其複視需要稜鏡矯正。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。