Macular translocation with 360-degree peripheral retinectomy - Impact of technique and surgical experience on visual outcomes

Purpose: To evaluate the impact of technique and surgical experience on complications and outcomes of macular translocation surgery with 360-degree peripheral retinectomy (MTS360). Methods: Twenty-six consecutive patients underwent MTS360 in a prospective study of macular translocation surgery for subfoveal choroidal neovascularization (CNV) in eyes with age-related macular degeneration (ARMD). Data gathered included intraoperative and postoperative events and pre- and postoperative standardized visual acuity recorded as number of letters read. Because the surgical technique changed particularly during the first 16 cases, patients were grouped into an evolving treatment group of the first 16 patients (Group 1) and a modified treatment group of the final 10 patients (Group 2). Results: As techniques evolved in this series, ease of surgery increased. There were significant decreases in surgery duration and in number of retinotomies required to induce artificial retinal detachment. Number of postoperative retinal detachments decreased from five in Group 1 to none in Group 2. Change in visual acuity was significantly different between the two groups: Group 1 had an average loss of 14 letters (<3 lines) and Group 2 an average gain of 3 letters (<1 line) (P < 0.05). Average postoperative visual acuity was significantly better for Group 2 (68 letters, approximately 20/80) than for Group 1 (47 letters, approximately 20/250) (P < 0.01). Conclusion: Surgical experience and a progressively modified surgical technique decreased perioperative complications and improved visual outcomes after MTS360. With modified MTS360, central vision has been salvaged for almost 1 year of follow-up in patients presenting with vision loss from subfoveal CNV and ARMD.