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. 2000 Apr;84(4):352–357. doi: 10.1136/bjo.84.4.352

Foveal relocation by redistribution of the neurosensory retina

D Wong 1, N Lois 1
PMCID: PMC1723438  PMID: 10729290

Abstract

AIM—To describe a new surgical technique for foveal relocation, and to report the outcome in nine patients treated with this procedure.
METHODS—Nine consecutive patients with subfoveal choroidal neovascular membranes (CNVMs) secondary to age related macular degeneration underwent foveal relocation surgery by redistribution of the neurosensory retina (RNR). The technique involved induction of a retinal detachment via a single retinotomy, relocation of the fovea by "sweeping" the retinal tissue with a retinal brush, and stabilisation of the retina in its new location using perfluorocarbon liquid peroperatively and silicone oil postoperatively.
RESULTS—In eight of nine eyes successful relocation of the fovea was achieved; in one eye the CNVM remained in a subfoveal location postoperatively. Visual acuity improved in two eyes, remained unchanged in three, and decreased in four eyes after a median follow up of 4 months (range 2.5-6 months). Complications included rupture of a foveal cyst with the development of a macular hole in one eye and epimacular membrane formation in another eye. In two eyes, macular retinal vessel closure occurred at the time of laser photocoagulation; one of these eyes later developed cystoid macular oedema and the other an epiretinal membrane. Recurrence of the CNVM was observed in one eye, but was controlled with further laser treatment.
CONCLUSIONS—Foveal relocation by RNR appears to be feasible, obviating the need for extensive retinotomies or scleral shortening.



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Figure 1  .

Figure 1  

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Scheme representing the manoeuvre used to achieve a total retinal detachment. Once detachment of one quarter to one third of the retina was obtained by infusion of saline into the subretinal space, the air filled eye was subjected to a gentle rocking motion (arrows) (top). The inertia created by the weight of the subretinal fluid (bottom) was used to extend the detachment "tidally".

Figure 2  .

Figure 2  

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Using a retinal brush the shallowly detached fovea was relocated by gently "sweeping" the retinal tissue.

Figure 3  .

Figure 3  

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(A) Preoperative fluorescein angiogram of the left eye of patient 1, showing dye leakage from a classic subfoveal CNVM. A halo of hypofluorescence corresponded to a ring of hyperpigmentation on fundus examination. The centre of the fovea was located within the pigmented ring (arrowhead). (B) Postoperatively, the CNVM was extrafoveal (arrowhead indicates site of fovea after relocation).

Figure 4  .

Figure 4  

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Preoperative fluorescein angiogram of the right eye of patient 3 with a very large classic subfoveal CNVM. Early (A) and late (B) frames of the angiogram are shown. Arrowhead indicates the site of the fovea. (C) Postoperatively, the fovea (large arrowhead) was relocated superonasally. Note the superonasal displacement of the retinal vessels (arrows), and the area of hyperfluorescence which corresponded to RPE changes observed on slit lamp biomicroscopy (small arrowheads). (D) Two weeks after photocoagulation, closure of the CNVM was noted.

Figure 5  .

Figure 5  

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(A) Preoperative fluorescein angiogram of the left eye of patient 4 showing a subfoveal CNVM. A classic and an occult (arrows) component were present. (B) Postoperatively, the CNVM was extrafoveal (arrowhead indicates relocated fovea). (C) Two weeks after laser treatment, incomplete closure of the CNVM was observed—that is, an area of persistence of CNVM in the non-foveal side was appreciated but remained stable with no further treatment during the follow up.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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