Macular Translocation for Neovascular AMD

In this case from Drs. Murtaza K. Adam and Carl H. Park, a macular translocation surgery is performed in a patient with AMD and counting fingers visual acuity due to a large disciform scar. The patient had previously undergone pars plana vitrectomy with injection of subretinal tissue plasminogen activator for a large submacular hemorrhage, and showed secondary geographic atrophy (GA). After initiating a standard 3 port 23-gauge vitrectomy, posterior and temporal retinal detachment is induced by subretinal injections, and the macula is gently peeled off the posterior pole following 360-degree retinectomy. The regressed choroidal neovascular membrane is removed from the subretinal space using ILM forceps, and the macula and fovea are gently translocated to an area with intact retinal pigment epithelium superior to the area of GA and subretinal hemorrhage. A 360-degree endo laser is applied to the edge of the retinectomy, an air fluid exchange is performed, and the surgery is completed by filling the vitreous cavity with silicone oil.