Sight-Saving Surgery Shows Promise, but Not Without Risk
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Brill's surgeon, Judy E. Kim, MD, tells WebMD that while the operation is performed on an outpatient basis, it still carries many risks. "We deal not only with the eye situation, we have to gauge patients' health and social situation when recommending this procedure," says Kim.
Kim, assistant professor at the Eye Institute of the Medical College of Wisconsin in Milwaukee, says the new technique uses an injection of salt solution to gently detach the retina. "We try to move the retina downward so the macula no longer sits over the blood vessel," she says. "[Then we] just sort of twist the whole thing [the macula] around like a turntable or a pizza. The center is held in place and you just spin it around." A few days later, the blood vessels are treated with the laser. "It is not a risk-free procedure and is labor intensive, but when it works, vision improvement can be intense in patients with no other options."
But few patients do quite as well as Brill. "It depends on what you start with, but going from 20/400 to 20/40 is extremely rare," says de Juan, who has performed the procedure more than 400 times. "Only 20% of patients [will improve significantly]." Of the other patients, he says about 40% have less, but still significant, improvement and another 40% will have worsening of their vision.
According to de Juan, eye surgeons are getting better at identifying which patients would benefit the most from the procedure since this would not work for all patients with AMD. In the future, he predicts this will allow for a more aggressive approach to AMD treatment in the appropriate patient.
Levent Akduman, MD, of The Retina Center in St. Louis, tells WebMD that with greater experience, even full macular translocation is becoming an attractive option. "With new techniques, in the next year or two we will have a success rate of about 50% with full translocation," he predicts. He says the procedure, for some, "offers hope of regaining legal-driving vision. ... I definitely emphasize to patients that this is extensive surgery that may take six hours to do and may result in losing the eye. But the patients know it is the only chance for better vision in their eye. Again, we have come really quite a long way since 1996 when I started doing this. This surgery has a lot better chance than it did four or five years ago."
De Juan can be seen performing a limited macular translocation in a real-time video on the Internet at www.vitreoussociety.org