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Foveal translocation surgery and myopic subfoveal CNV membrane
Letters to the Editor 3. Kostulas K, Crisby M, Huang WX, et al. A methylenetetrahydrofolate reductase gene polymorphism in ischaemic stroke and in carotid artery stenosis. Eur J Clin Invest 1998;28:285–9. 4. McQuillan BM, Beilby JP, Nidorf M, et al. Hyperhomocysteinemia but not the C677T mutation of methylenetetrahydrofolate reductase is an independent risk determinant of carotid wall thickening. The Perth Carotid Ultrasound Disease Assessment Study. Circulation 1999;99:2383– 8. 5. Akar N, Akar E, Deda G, et al. Factor V1691 G-A, prothrombin 20210 G-A, and methylenetetrahydrofolate reductase 677 C-T variants in Turkish children with cerebral infarct. J Child Neurol 1999;14:749 –51.
disciform scar and the fellow eye has a newly developed neovascular membrane. OSMAN Cខ EKICខ , MD MASAHITO OHJI, MD TAKASHI FUJIKADO, MD XIAO YUN FANG, MD ATSUSHI HAYASHI, MD SHUNJI KUSAKA, MD YASUO TANO, MD Osaka, Japan References
Foveal Translocation Surgery and Myopic Subfoveal CNV Membrane Dear Editor: Tabandeh et al1 reported the natural course of visual outcomes in older patients with untreated myopic choroidal neovascularization (CNV) and compared their results with those of untreated and treated patients from series reported elsewhere. They discussed the outcomes of photocoagulation and submacular surgery in older patients with high myopia and CNV. They suggested that further studies of alternative treatments such as surgical removal of CNV and photodynamic therapy are warranted. We present another possible treatment method, foveal translocation surgery. Foveal or macular translocation surgery was initially considered and applied for subfoveal CNV from age-related macular degeneration.2 Other promising results later followed.3– 6 Most patients with subfoveal CNV are not eligible for laser therapy, and the excision of CNV does not improve central retinal sensitivity and results in poor visual outcome.7,8 We performed foveal translocation, for the first time, in three patients with myopic subfoveal CNV membrane.3,9,10 Our previously reported results are as follows. The first patient was a 70-year-old woman with myopic CNV and bilateral myopic degeneration. Foveal translocation with retinotomy was performed to her eye that had recent visual loss. Best-corrected visual acuity improved from 20/700 before surgery to 20/70 at 19 months after surgery.3 Her visual acuity remained stable, with an acuity of 20/150 at 38 months of follow-up.9 The second patient was a 40-year-old woman with a history of bilateral myopic macular degeneration. She had experienced recent visual loss in one eye. Intravenous fluorescein and indocyanine green angiography by scanning laser ophthalmoscope disclosed a subfoveal CNV membrane in the right eye. This eye underwent foveal translocation with scleral shortening. Her best-corrected visual acuity improved from 20/150 to 20/20 6 months after surgery10 and decreased to 20/30 9 months after surgery.9 The third patient was a 52-year-old woman with bilateral myopic degeneration and CNV. Her eye with recent visual loss underwent translocation of the fovea with scleral shortening. Acuity improved from 20/70 to 20/30 6 months after surgery.10 Foveal translocation may be considered as a treatment option for patients with bilateral myopic degeneration in whom one eye has severe visual loss resulting from a
1. Tabandeh H, Flynn HW Jr, Scott IU, et al. Visual acuity outcomes of patients 50 years of age and older with high myopia and untreated choroidal neovascularization. Ophthalmology 1999;106:2063–7. 2. Machemer R, Steinhorst UH. Retinal separation, retinotomy, and macular relocation: II. A surgical approach for age-related macular degeneration? Graefes Arch Clin Exp Ophthalmol 1993;231:635– 41. 3. Ninomiya Y, Lewis JM, Hasegawa T, Tano Y. Retinotomy and foveal translocation for surgical management of subfoveal choroidal neovascular membranes. Am J Ophthalmol 1996; 122:613–21. 4. de Juan E Jr, Loewenstein A, Bressler NM, Alexander J. Translocation of the retina for management of subfoveal choroidal neovascularization II: a preliminary report in humans. Am J Ophthalmol 1998;125:635– 46. 5. Fujikado T, Ohji M, Hayashi A, et al. Anatomic and functional recovery of the fovea after foveal translocation surgery without large retinotomy and simultaneous excision of a neovascular membrane. Am J Ophthalmol 1998;126:839 – 42. 6. Eckardt C, Eckardt U, Conrad HG. Macular rotation with and without counter-rotation of the globe in patients with agerelated macular degeneration. Graefes Arch Clin Exp Ophthalmol 1999;237:313–25. 7. Cខ ekicខ O, Ohji M, Hayashi A, et al. Foveal translocation surgery in age-related macular degeneration [letter]. Lancet 1999;354:340. Comment on: Lancet 1999;353:818. 8. Tsujikawa M, Tsujikawa K, Lewis JM, Tano Y. Change in retinal sensitivity due to excision of choroidal neovascularization and its influence on visual acuity outcome. Retina 1999; 19:135– 40. 9. Ohji M, Fujikado T, Saito Y, et al. Foveal translocation: a comparison of two techniques. Semin Ophthalmol 1998;13: 52– 62. 10. Fujikado T, Ohji M, Saito Y, et al. Visual function after foveal translocation with scleral shortening in patients with myopic neovascular maculopathy. Am J Ophthalmol 1998;125:647– 56.
Nuremberg Chronicle Woodcut Illustration Dear Editor: The woodcut illustration from the Nuremberg Chronicle of 1493 shown in the “Historical Image” section (Ophthalmology 2000;107:499) is often suggested as the first printed illustration of spectacles. An earlier representation comes from the Rudimentum Novitiorum, Lubeck: Lucas Brandis, 1475 (Fig 1). This woodcut shows Philo, the Alexandrian philosopher, working at his desk. With a pen in one hand and a penknife in the other, he writes on a scroll of parchment, a pair of spectacles perched precariously on his nose.
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disciform scar and the fellow eye has a newly developed neovascular membrane. OSMAN Cខ EKICខ , MD MASAHITO OHJI, MD TAKASHI FUJIKADO, MD XIAO YUN FANG, MD ATSUSHI HAYASHI, MD SHUNJI KUSAKA, MD YASUO TANO, MD Osaka, Japan References
Foveal Translocation Surgery and Myopic Subfoveal CNV Membrane Dear Editor: Tabandeh et al1 reported the natural course of visual outcomes in older patients with untreated myopic choroidal neovascularization (CNV) and compared their results with those of untreated and treated patients from series reported elsewhere. They discussed the outcomes of photocoagulation and submacular surgery in older patients with high myopia and CNV. They suggested that further studies of alternative treatments such as surgical removal of CNV and photodynamic therapy are warranted. We present another possible treatment method, foveal translocation surgery. Foveal or macular translocation surgery was initially considered and applied for subfoveal CNV from age-related macular degeneration.2 Other promising results later followed.3– 6 Most patients with subfoveal CNV are not eligible for laser therapy, and the excision of CNV does not improve central retinal sensitivity and results in poor visual outcome.7,8 We performed foveal translocation, for the first time, in three patients with myopic subfoveal CNV membrane.3,9,10 Our previously reported results are as follows. The first patient was a 70-year-old woman with myopic CNV and bilateral myopic degeneration. Foveal translocation with retinotomy was performed to her eye that had recent visual loss. Best-corrected visual acuity improved from 20/700 before surgery to 20/70 at 19 months after surgery.3 Her visual acuity remained stable, with an acuity of 20/150 at 38 months of follow-up.9 The second patient was a 40-year-old woman with a history of bilateral myopic macular degeneration. She had experienced recent visual loss in one eye. Intravenous fluorescein and indocyanine green angiography by scanning laser ophthalmoscope disclosed a subfoveal CNV membrane in the right eye. This eye underwent foveal translocation with scleral shortening. Her best-corrected visual acuity improved from 20/150 to 20/20 6 months after surgery10 and decreased to 20/30 9 months after surgery.9 The third patient was a 52-year-old woman with bilateral myopic degeneration and CNV. Her eye with recent visual loss underwent translocation of the fovea with scleral shortening. Acuity improved from 20/70 to 20/30 6 months after surgery.10 Foveal translocation may be considered as a treatment option for patients with bilateral myopic degeneration in whom one eye has severe visual loss resulting from a
1. Tabandeh H, Flynn HW Jr, Scott IU, et al. Visual acuity outcomes of patients 50 years of age and older with high myopia and untreated choroidal neovascularization. Ophthalmology 1999;106:2063–7. 2. Machemer R, Steinhorst UH. Retinal separation, retinotomy, and macular relocation: II. A surgical approach for age-related macular degeneration? Graefes Arch Clin Exp Ophthalmol 1993;231:635– 41. 3. Ninomiya Y, Lewis JM, Hasegawa T, Tano Y. Retinotomy and foveal translocation for surgical management of subfoveal choroidal neovascular membranes. Am J Ophthalmol 1996; 122:613–21. 4. de Juan E Jr, Loewenstein A, Bressler NM, Alexander J. Translocation of the retina for management of subfoveal choroidal neovascularization II: a preliminary report in humans. Am J Ophthalmol 1998;125:635– 46. 5. Fujikado T, Ohji M, Hayashi A, et al. Anatomic and functional recovery of the fovea after foveal translocation surgery without large retinotomy and simultaneous excision of a neovascular membrane. Am J Ophthalmol 1998;126:839 – 42. 6. Eckardt C, Eckardt U, Conrad HG. Macular rotation with and without counter-rotation of the globe in patients with agerelated macular degeneration. Graefes Arch Clin Exp Ophthalmol 1999;237:313–25. 7. Cខ ekicខ O, Ohji M, Hayashi A, et al. Foveal translocation surgery in age-related macular degeneration [letter]. Lancet 1999;354:340. Comment on: Lancet 1999;353:818. 8. Tsujikawa M, Tsujikawa K, Lewis JM, Tano Y. Change in retinal sensitivity due to excision of choroidal neovascularization and its influence on visual acuity outcome. Retina 1999; 19:135– 40. 9. Ohji M, Fujikado T, Saito Y, et al. Foveal translocation: a comparison of two techniques. Semin Ophthalmol 1998;13: 52– 62. 10. Fujikado T, Ohji M, Saito Y, et al. Visual function after foveal translocation with scleral shortening in patients with myopic neovascular maculopathy. Am J Ophthalmol 1998;125:647– 56.
Nuremberg Chronicle Woodcut Illustration Dear Editor: The woodcut illustration from the Nuremberg Chronicle of 1493 shown in the “Historical Image” section (Ophthalmology 2000;107:499) is often suggested as the first printed illustration of spectacles. An earlier representation comes from the Rudimentum Novitiorum, Lubeck: Lucas Brandis, 1475 (Fig 1). This woodcut shows Philo, the Alexandrian philosopher, working at his desk. With a pen in one hand and a penknife in the other, he writes on a scroll of parchment, a pair of spectacles perched precariously on his nose.
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