Macular translocation with 360 degrees retinotomy for exudative age-related macular degeneration.

BACKGROUND: Macular rotation surgery comprises surgical extraction of choroidal neovascular membranes in age-related macular degeneration (AMD) and translocation of the foveal neural retina over adjacent retinal pigment epithelium. OBJECTIVE: To determine whether macular translocation with 360 degrees retinotomy can stabilize and/or improve visual acuity in patients with subfoveal choroidal neovascularization (CNV) secondary to AMD. DESIGN: This study consisted of a standardized surgical procedure on a series of 90 consecutive patients and follow-up examinations at fixed intervals for 12 months. PARTICIPANTS: All patients in this study had experienced recent visual loss resulting from subfoveal CNV caused by AMD. Twenty-six patients had major macular subretinal hemorrhage, 39 patients had occult subfoveal CNV, and 25 patients had classic subfoveal CNV. METHODS: Macular translocation surgery was performed between 1997 and 1999. The patients were examined preoperatively and at 3, 6, and 12 months postoperatively, including visual acuity, microperimetry, angiography, and orthoptic assessment. RESULTS: Visual acuity increased by 15 or more letters in 24 patients, remained stable in 37 patients, and deteriorated by 15 or more letters in 29 patients at 12 months postoperatively. A secondary procedure was necessary in 17 patients because of severe complications; proliferative vitreoretinopathy was observed in 17 eyes, macular pucker in 5 eyes, and macular hole in 1 patient. CONCLUSION: Macular translocation is a technically demanding surgical procedure. Although the procedure has a high rate of surgical and postoperative complications, the functional and anatomical results appear to be promising for selected patients with subfoveal CNV secondary to AMD.

Effects of the protein tyrosine kinase inhibitor genistein and taurine on retinal function in isolated superfused retina.

BACKGROUND: Genistein has the potential to act as an intraocular antiangiogenic agent. Its therapeutical use, however, is limited by toxic side effects on the retina. This study was designed to evaluate the simultaneous use of taurine as a neuroprotective drug. METHODS: Bovine retinas were isolated and perfused with an oxygen-preincubated nutrient solution. The electroretinogram (ERG) was recorded as a transretinal electrical potential using Ag/AgCl electrodes. At stable ERG amplitudes, genistein at concentrations of 11, 37, and 150 microM was added to the nutrient solution for 45 min, in the absence or presence of taurine (3 mM). Thereafter, the retina was reperfused with the nutrient solution for another 100 min. The percentage of b-wave reduction during genistein and genistein/taurine application was calculated. RESULTS: The b-wave amplitude was reduced by a smaller amount during the application of genistein (11 and 37 microM) in the presence of taurine compared with genistein alone. For both, genistein/taurine and genistein alone the b-wave recovered completely during the wash-out of the drugs. However, during the application of the highest tested concentration of genistein (150 microM), taurine did not protect completely, leading to an irreversible b-wave reduction. CONCLUSIONS: The adjuvant use of taurine reduces the genistein-induced retinal toxicity to a certain degree. However, the protective effect of taurine is limited and there is only a narrow therapeutic index for a combined intravitreal administration of genistein in coapplication with taurine to inhibit pathological ocular neovascularization.

Safety profile of a taurine containing irrigation solution (AcriProTect) in pars plana vitrectomy.

PURPOSE: To evaluate the clinical safety of a taurine containing irrigation solution (AcriProTect) before its routine application in pars plana vitrectomy (PPV). METHODS: Twenty-five patients who underwent PPV were included in this prospective interventional clinical study. Standard irrigation solution containing the addendum 3 mmol/L taurine was used during PPV. Postoperative follow-up visits included a standard eye examination, corneal thickness measurements, endothelial cell counts, determination of the foveal thickness by optical coherence tomography (OCT), and an electrophysiologic examination. For statistical analysis Wilcoxon test was used. RESULTS: Significant improvement of visual acuity (VA) was observed at the 3- and 6-month controls (P = 0.024; P = 0.002 for 3 and 6 months, respectively). Endothelial cell counts and corneal thickness at 3 and 6 months were not significantly different from preoperative values (P = 0.204; P = 0.126 for endothelial cell count and P = 0.475; P = 0.095 for corneal thickness at 3 and 6 months, respectively). Both scotopic and photopic Ganzfeld electroretinography and electro-oculography did not show significant changes during the follow-up. No increase in complication rate was detected. CONCLUSIONS: The investigation demonstrates a good biocompatibility of taurine-containing irrigation solution developed for vitrectomy in humans concomitant with habitually observed good functional outcome.