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Lisa Catanese:
Writing Sample

New Surgical Procedure for Translocation of the Macula
Offers Patients New Hope

By Lisa Catanese

A new ophthalmologic procedure for translocation of the macula is offering new hope to patients with certain types of macular degeneration, the most common cause of blindness in the United States today.

This procedure is one of many advances developed by the Microsurgery Advanced Design Laboratory (MADLAB) at Hopkins’ renowned Wilmer Eye Institute. Eugene deJuan Jr., MD, director of the lab and co-director of the Wilmer Vitreoretinal Service, explains that the limited retinal translocation procedure was developed as a treatment for early (wet) macular degeneration.

"In the wet form, a new blood vessel grows underneath the fovea centralis, interfering with the function of the retina and ultimately leading to severe visual loss progressing to blindness," Dr. deJuan explains. "Before this procedure, the only treatment available was laser photocoagulation, which had reasonable effectiveness if the blood vessel was outside the fovea. However, once the membrane went under the center of the retina, the ultimate result was often legal blindness."

How It Is Done

With the limited retinal translocation technique, the neuro-sensory retina may be moved approximately 1 mm either inferiorly or superiorly relative to the underlying choroidal neovascularization. To accomplish this, the retina is detached by injection of a balanced salt solution into the subretinal space. The sclera is then shortened, and the retina is manipulated so that the macula is translocated relative to the underlying choroidal neovascularization.

A related technique involves cutting and moving the retina, but shortening the sclera is safer and quicker, Dr. deJuan states. "That’s the procedure we have concentrated most on and have been most involved in its development."

The translocation procedure carries a 2 percent to 5 percent risk of retinal detachment. Patients with subfoveal choroidal neovascularization of recent onset possess the greatest likelihood of successful retinal translocation. In approximately 250 cases performed at Wilmer, about a third of the patients showed improvement, a third remained stable, and a third experienced deteriorated vision. Of the individuals whose vision was enhanced, 10 percent experienced a dramatic improvement (20/25 to 20/60).

Almost all cases of macular degeneration occur after age 55. The causes are not fully understood, although the condition is thought to be linked to environmental factors, cigarette-smoking, diets deficient in green leafy vegetables, and genetic factors.

Because the procedure is most successful in cases of recent onset, symptoms of distorted or decreased central vision require urgent referral and evaluation, Dr. deJuan advises. "In cases where the blood vessel is small and damage to the retina is limited, we can restore and improve vision in many patients 30 to 40 percent," he explains. "It does offer hope for people with fresh lesions."

‘I Can’t Say Enough About Him’

For Leonard James of Brockport, N.Y., his vision changes began in January 1998. "I got glasses, and my eyes seemed to be fine," he said. "But then, by April, I noticed that I wasn’t seeing the newspaper very well."

A retinal specialist to whom he was referred indicated that not much could be done for him. Within months, he had retired from work because of his deteriorating vision. "I could barely drive, couldn’t read the paper or mail," he recalls. "I couldn’t see my grandchildren’s faces. I was ready to give up on everything. But then my daughter saw a program about Wilmer."

After a battle with his insurance company, Mr. James received approval to see Dr. deJuan at Wilmer, who determined he was a candidate for retinal translocation surgery. The procedure, Mr. James says, changed his life. "My left eye was helped tremendously. My right eye is stable and is not getting any worse. I can drive and read the newspaper now. My vision isn’t perfect, but I can see. I owe Dr. deJuan a lot – I can’t say enough about him and how he helped me."

About the MADLAB

The MADLAB at Wilmer is dedicated to improved patient care through the design and development of innovative equipment for microsurgery. In its five years of existence, it has built a reputation as a pioneer in advancing the art and science of surgery through the use of sound engineering and scientific principles.

The MADLAB today is focused upon four core areas of research and product development: instrument design and development, surgical augmentation devices, operative diagnostic technologies, and microsurgical education. It excels at identifying potential areas of innovation, generating unique solutions to clinical obstacles, and rapidly developing conceptual ideas into near-market-ready products.

Eugene deJuan Jr. earned his medical degree from the University of South Alabama College of Medicine. Before his work at Hopkins, he was an associate professor for the Duke University Department of Ophthalmology. He has received numerous professional awards and has been published extensively. He was appointed director of the MADLAB in 1992, and it has flourished under his guidance.

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