The Macula pp 85-94 | Cite as

Retrospective analysis of subretinal surgery

  • C. I. Falkner
  • S. Binder
  • H. Leitich


Background: Age-related macular degeneration (AMD) is the leading cause of legal blindness in people 50 years of age or older in the developed world. The treatment of AMD is still controversial and the search for a standard therapy for all forms of choroidal neovascularization (CNV) is on-going. Few randomized clinical trials are available regarding the surgical treatment of AMD. We performed a systematic review to determine the effectiveness of subretinal surgery for AMD and to summarize the reported results.

Methods: A MEDLINE search for the years 1992–2001 was conducted. Only original English- or German-language studies evaluating surgical interventions in AMD were assigned to one of four groups of surgical treatments. The main outcomes were improvement or deterioration of visual acuity (VA) after surgery.

Results: Sixty one studies met the inclusion criteria. The surgical procedures performed were removal of subfoveal choroidal neovascularization (CNV) (43%), macular translocation (25%), transplantation of pigment epithelium (10%) and removal of subretinal hemorrhage (23%). Thirty eight percent (range 0–87%) of all cases showed an improvement of VA and 26% (range 0–90%) a deterioration.

Conclusion: Compared to the natural course of AMD, subretinal surgery appears to be a promising method for the treatment of AMD. More randomized clinical studies are needed to draw unbiased conclusions and to allow for standard recommendations.


Subretinal Hemorrhage Preoperative Visual Acuity Submacular Hemorrhage Choroidal Neovascular Membrane IriS Pigment Epithelium 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Klein R, Klein BEK, Jensen SC, Meuer SM (1997) The five-year incidence and progression of age-related maculopathy. The Beaver Dam Eye Study. Ophthalmology 104: 7–21PubMedGoogle Scholar
  2. 2.
    Bressler NM, Bressler SB, Fine SL (1988) Age-related macular degeneration. Sury Ophthalmol 32: 375–413CrossRefGoogle Scholar
  3. 3.
    Votruba M, Gregor Z (2001) Neovascular age-related macular degeneration: present and future options. Eye 15: 424–9PubMedCrossRefGoogle Scholar
  4. 4.
    Submacular Surgery Trials Pilot Study Investigators (2000) Submacular Surgery Trials randomized pilot trial of laser photocoagulation versus surgery for recurrent choroidal neovascularization secondary to age-related macular degeneration: I. ophthalmic outcomes. Submacular Surgery Trials Pilot Study report number 1. Am J Ophthalmol 130: 387–407CrossRefGoogle Scholar
  5. 5.
    Thomas MA, Grand MG, Williams DF, et al (1992) Surgical management of subfoveal choroidal neovascularization. Ophthalmology 99: 952–68PubMedGoogle Scholar
  6. 6.
    Lewis H, VanderBrug Medendorp S (1997) Tissue plasminogen activator-assisted surgical excision of subfoveal choroidal neovascularization in age-related macular degeneration. a randomized, double-masked trial. Ophthalmology 104: 1847–51PubMedGoogle Scholar
  7. 7.
    Ormerod LD, Puklin JE, Frank RN (1994) Long-term outcomes after the surgical removal of advanced subfoveal neovascular membranes in age-related macular degeneration. Ophthalmology 101: 1201–10PubMedGoogle Scholar
  8. 8.
    Scheider A, Gündisch O, Kampik A (1999) Surgical extraction of subfoveal choroidal new vessels and submacular haemorrhage in age-related macular degeneration: results of a prospective study. Graefes Arch Clin Exp Ophthalmol 237: 10–15PubMedCrossRefGoogle Scholar
  9. 9.
    Deramo VA, Meyer CH, Toth CA (2001) Successful macular translocation with temporary sclera) infolding using absorbable suture. Retina 21: 304–11PubMedCrossRefGoogle Scholar
  10. 10.
    Freedman SF, Seaber JH, Buckley EG, et al (2000) Combined superior oblique muscle recession and inferior oblique muscle advancement and transposition for cyclotorsion associated with macular translocation surgery. J AAPOS 4: 75–83PubMedCrossRefGoogle Scholar
  11. 11.
    Glacet-Bernard A, Simon P, Hamelin N, et al (2001) Translocation of the macula for management of subfoveal choroidal neovascularization: comparison of results in age-related macular degeneration and degenerative myopia. Am J Ophthalmol 131: 78–89PubMedCrossRefGoogle Scholar
  12. 12.
    Lewis H, Kaiser PK, Lewis S, Estafanous M (1999) Macular translocation for subfoveal choroidal neovascularization in age-related macular degeneration: a prospective study. Am J Ophthalmol 128: 135–46PubMedCrossRefGoogle Scholar
  13. 13.
    Lewis H (2001) Macular translocation with chorioscleral outfolding: a pilot clinical study. Am J Ophthalmol 132: 156–63PubMedCrossRefGoogle Scholar
  14. 14.
    Lappas A, Weinberger AWA, Foerster AMH, et al (2000) Iris pigment epithelial cell transplantation in exudative age-related macular degeneration. A pilot study in patients. Graefes Arch Clin Exp Ophthalmol 238: 631–41PubMedCrossRefGoogle Scholar
  15. 15.
    Lewis H (1994) Intraoperative fibrinolysis of submacular hemorrhage with tissue plasminogen activator and surgical drainage. Am J Ophthalmol 118: 559–68PubMedGoogle Scholar
  16. 16.
    Bottoni F, Airaghi P, Perego E, et al (1996) Surgical removal of idiopathic, myopic and age-related subfoveal neovascularization. Graefes Arch Clin Exp Ophthalmol 234: 542–550CrossRefGoogle Scholar
  17. 17.
    Corey RP, Scott IL), Flynn HW, et al (2001) Surgical removal of submacular choroidal neovascularization: a clinicopathologic study and factors influencing visual outcomes. Ophthalmic Surg Lasers 32: 406–18Google Scholar
  18. 18.
    Merrill PT, LoRusso FJ, Lomeo MD, et al (1999) Surgical removal of subfoveal choroidal neovascularization in age-related macular degeneration. Ophthalmology 106: 782–9PubMedCrossRefGoogle Scholar
  19. 19.
    Mietz H, Merrill PT, Lambert HM, Font RL (1997) Combined subretinal and sub-retinal pigment epithelium neovascular membranes in age-related macular degeneration: a clinicopathologic study of six cases. Ophthalmic Surg Lasers 28: 645–52PubMedGoogle Scholar
  20. 20.
    Nasir MA, Sugino I, Zarbin MA (1997) Decreased choriocapillaris perfusion following surgical excision of choroidal neovascular membranes in age-related macular degeneration. Br J Ophthalmol 81: 481–9PubMedCrossRefGoogle Scholar
  21. 21.
    Roth DB, Downie AA, Charles ST (1997) Visual results after submacular surgery for neovascularization in age-related macular degeneration. Ophthalmic Surg Lasers 28: 920–5PubMedGoogle Scholar
  22. 22.
    Thach AB, Marx JL, Frambach DA, et al (1996) Choroidal hypoperfusion after surgical excision of subfoveal neovascular membranes in age-related macular degeneration. Int Ophthalmol 20: 205–13PubMedGoogle Scholar
  23. 23.
    Thomas MA, Dickinson JD, Melberg NS, et al (1994) Visual results after surgical removal of subfoveal choroidal neovascular membranes. Ophthalmology 101: 1384–96PubMedGoogle Scholar
  24. 24.
    Benner JD, Meyer CH, Shirkey BL, Toth CA (2001) Macular translocation with radial sclera) outfolding: experimental studies and initial human results. Graefes Arch Clin Exp Ophthalmol 239: 815–23PubMedCrossRefGoogle Scholar
  25. 25.
    Kim T, Krishnasamy S, Meyer CH, Toth CA (2001) Induced corneal astigmatism after macular translocation surgery with sclerai infolding. Ophthalmology 108: 1203–8PubMedCrossRefGoogle Scholar
  26. 26.
    Ohji M, Fujikado T, Kusaka S, et al (2001) Comparison of three techniques of foveal translocation in patients with subfoveal choroidal neovascularization resulting from age-related macular degeneration. Am J Ophthalmol 132: 888–96PubMedCrossRefGoogle Scholar
  27. 27.
    Pieramici DJ,, de Juan E, Fujii GY et al (2000) Limited inferior macular translocation for the treatment of subfoveal choroidal neovascularization secondary to age-related macular degeneration. Am J Ophthalmol 130: 419–28PubMedCrossRefGoogle Scholar
  28. 28.
    Haupert CL, McCuen BW, Jaffe GJ, et al (2001) Pars plana vitrectomy, subretinal injection of tissue plasminogen activator, and fluid-gas exchange for displacement of thick submacular hemorrhage in age related macular degeneration. Am J Ophthalmol 131: 208–15PubMedCrossRefGoogle Scholar
  29. 29.
    Hesse L, Meitinger D, Schmidt J (1997) Little effect of tissue plasminogen activator in sub-retinal surgery for acute hemorrhage in age-related macular degeneration. Ger J Ophthalmol 5: 479–83Google Scholar
  30. 30.
    Lim JI, Drews-Botsch C, Sternberg P, et al (1995) Submacular hemorrhage removal. Ophthalmology 102: 1393–9PubMedGoogle Scholar
  31. 31.
    Abe T, Yoshida M, Kano T, Tamai M (2001) Visual function after removal of subretinal neovascular membranes in patients with age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 293: 927–36CrossRefGoogle Scholar
  32. 32.
    Berger AS, Kaplan HJ (1992) Clinical experience with the surgical removal of subfoveal neovascular membranes. Short-term postoperative results. Ophthalmology 99: 969–76PubMedGoogle Scholar
  33. 33.
    Brindeau C, Glacet-Bernard A, Coscas F, et al (2001) Surgical removal of subfoveal choroidal neovascularization: visual outcome and prognostic value of fluorescein angiography and optical coherence tomography. Eur J Ophthalmol 11: 287–95PubMedGoogle Scholar
  34. 34.
    Eckardt C (1996) Chirurgische Entfernung von submakulären Neovaskularisationsmembranen. Ophthalmologe 93: 688–93PubMedCrossRefGoogle Scholar
  35. 35.
    Ehrt O, Scheider A, Gündisch O, et al (1999) Chirurgische Entfernung subfovealer choroidaler Neovaskularisationen bei AMD. Prä- and postoperative fundusperimetrische Befunde mit dem SLO. Ophthalmologe 96: 421–7PubMedCrossRefGoogle Scholar
  36. 36.
    Gandorfer A, Scheider A, Gündisch O, Kampik A (1998) Rezidivierende choroidale Neovaskularisationen bei altersbezogener Makuladegeneration. Fluoreszenzangiographische Morphologie nach chirurgischer Membranektomie. Ophthalmologe 95: 408–12PubMedCrossRefGoogle Scholar
  37. 37.
    Hudson HL, Frambach DA, Lopez PF (1995) Relation of the functional and structural fundus changes after submacular surgery for neovascular age-related macular degeneration. Br J Ophthalmol 79: 417–23PubMedCrossRefGoogle Scholar
  38. 38.
    Loewenstein A, Sunness JS, Bressler NM, et al (1998) Scanning laser ophthalmoscope fundus perimetry after surgery for choroidal neovascularization. Am J Ophthalmol 125: 657–65PubMedCrossRefGoogle Scholar
  39. 39.
    Müller S, Ehrt O, Gündisch O, et al (2000) Funktionelle Ergebnisse nach CNV-Extraktion oder Photokoagulation bei alterskorrelierter Makuladegeneration. Ophthalmologe 97: 142–6PubMedCrossRefGoogle Scholar
  40. 40.
    Park KH, Yu HG, Yu YS, et al (1999) Surgical treatment of subretinal neovascular membrane. Korean J Ophthalmol 13: 30–5PubMedGoogle Scholar
  41. 41.
    Strmen P, Hasa J (1996) Surgical removal of large subretinal neovascular membranes: results and complications. Int Ophthalmol 20: 165–9PubMedGoogle Scholar
  42. 42.
    Tsujikawa M, Tsujikawa K, Lewis JM, Tano Y (1999) Change in retinal sensitivity due to excision of choroidal neovascularization and its influence on visual acuity outcome. Retina 19: 135–40PubMedCrossRefGoogle Scholar
  43. 43.
    Yuzawa M, Isomae T, Mori R, et al (2001) Surgical excision versus laser photocoagulation for subfoveal choroidal neovascular membrane with age-related macular degeneration: comparison of visual outcomes. Jpn J Ophthalmol 45: 192–8PubMedCrossRefGoogle Scholar
  44. 44.
    Akduman L, Karavellas MP, Macdonald JC, et al (1999) Macular translocation with retinotomy and retinal rotation for exudative age-related macular degeneration. Retina 19: 418–23PubMedCrossRefGoogle Scholar
  45. 45.
    Buffenn AN, de Juan E, Fujii G, Hunter DG (2001) Diplopia after limited macular translocation surgery. J AAPOS 5: 388–94Google Scholar
  46. 46.
    Eckardt C, Eckardt U, Conrad HG (1999) Macular rotation with and without counter-rotation of globe in patients with age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 237: 313–25PubMedCrossRefGoogle Scholar
  47. 47.
    Ohji M, Fujikado T, Saito Y, et al (1998) Foveal translocation: a comparison of two techniques. Sem Ophthalmol 13: 52–61CrossRefGoogle Scholar
  48. 48.
    Wolf S, Lappas A, Weinberger AWA, Kirchhof B (1999) Macular translocation for surgical management of subfoveal choroidal neovascularizations in patients with AMD: first results. 237: 51–7Google Scholar
  49. 49.
    Wong D, Lois N (2000) Foveal relocation by redistribution of the neurosensory retina. Br J Ophthalmol 84: 352–7PubMedCrossRefGoogle Scholar
  50. 50.
    Abe T, Yoshida M, Tomita H, et al (2000) Auto iris pigment epithelial cell transplantation in patients with age-related macular degeneration: short-term results. Tohoku J Exp Med 191: 7–20PubMedCrossRefGoogle Scholar
  51. 51.
    Algvere PV, Berglin L, Gouras P, Sheng Y (1994) Transplantation of fetal retinal pigment epithelium in age-related macular degeneration with subfoveal neovascularization. Graefes Arch Clin Exp Ophthalmol 232: 707–16PubMedCrossRefGoogle Scholar
  52. 52.
    Algvere PV, Gouras P, Dafgârd-Kopp E (1999) Long-term outcome of RPE allografts in non-immunosuppressed patients with AMD. Eur J Ophthalmol 9: 217–30PubMedGoogle Scholar
  53. 53.
    Stanga PE, Kychenthal A, Fitzke FW, et al (2001) Retinal pigment epithelium translocation and central visual function in age related macular degeneration: preliminary results. Int Ophthalmol 23: 297–307PubMedCrossRefGoogle Scholar
  54. 54.
    Thumann G, Aisenbrey S, Schraermeyer U, et al (2000) Transplantation of autologous iris pigment epithelium after removal of choroidal neovascular membranes. Arch Ophthalmol 118: 1350–5PubMedGoogle Scholar
  55. 55.
    Chaudhry NA, Mieler WF, Han DP, et al (1999) Preoperative use of tissue plasminogen activator for large submacular hemorrhage. Ophthalmic Surg Lasers 30: 176–80PubMedGoogle Scholar
  56. 56.
    Claes C, Zivojnovic R (1996) Efficacy of tissue plasminogen activator (t-PA) in subretinal hemorrhage removal. Bull Soc Belge Opthalmol 261: 115–18Google Scholar
  57. 57.
    Heidenkummer HP, Kampik A (1995) Chirurgische Extraktion subretinaler Pseudotumoren bei altersbezogener Makuladegeneration (AMD). Klinische, morphologische and immunhistochemische Ergebnisse. Ophthalmologe 92: 631–9PubMedGoogle Scholar
  58. 58.
    Ibanez HE, Williams DF, Thomas MA, et al (1995) Surgical management of submacular hemorrhage. A series of 47 consecutive cases. Arch Ophthalmol 113: 62–9PubMedCrossRefGoogle Scholar
  59. 59.
    Kamei M, Tano Y, Maeno T, et al (1996) Surgical removal of submacular hemorrhage using tissue plasminogen activator and perfluorocarbon liquid. Am J Ophthalmol 121: 267–75PubMedGoogle Scholar
  60. 60.
    Krasnov MM, Stolyarenko GE (1992) Surgical management of exsudative maculopathies: preliminary report. Eur J Ophthalmol 2: 122–8PubMedGoogle Scholar
  61. 61.
    Lambert HM, Capone A, Aaberg TM, et al (1992) Surgical excision of subfoveal neovascular membranes in age-related macular degeneration. Am J Ophthalmol 113: 257–62PubMedGoogle Scholar
  62. 62.
    Mandelcorn MS, Menezes AV (1993) Surgical removal of subretinal hemorrhage and choroidal neovascular membranes in acute hemorrhagic age-related macular degeneration. Can J Ophthalmol 28: 19–23PubMedGoogle Scholar
  63. 63.
    Moriarty AP, McAllister IL, Constable IJ (1995) Initial clinical experience with tissue plasminogen activator (tPA) assisted removal of submacular haemorrhage. Eye 9: 582–8PubMedCrossRefGoogle Scholar
  64. 64.
    Treatment of age-related macular degeneration with Photodynamic Therapy (TAP) Study Group (2001) Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteprofin. Two-year results of 2 randomized clinical trials-TAP Report 2. Arch Ophthalmol 119: 198–207Google Scholar

Copyright information

© Springer-Verlag/Wien 2004

Authors and Affiliations

  • C. I. Falkner
    • 1
  • S. Binder
    • 1
  • H. Leitich
    • 2
  1. 1.The Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Department of OphthalmologyRudolf Foundation ClinicViennaAustria
  2. 2.Department of Obstetrics and GynecologyUniversity of ViennaViennaAustria

Personalised recommendations