Full macular translocation versus photodynamic therapy with verteporfin in the treatment of neovascular age-related macular degeneration: 1-year results of a prospective, controlled, randomised pilot trial (FMT-PDT).

BACKGROUND: The purpose of this study was to compare full macular translocation (FMT) with photodynamic therapy (PDT) in the treatment of neovascular age-related macular degeneration (AMD). METHODS: In a prospective, randomised, non-masked, mono-center, pilot-trial, 50 eyes of 50 patients were assigned to either FMT or PDT. Baseline and control examinations in 3-monthly intervals over a 12-month period included standardized protocol refraction, visual acuity testing and fluorescein angiography. Primary outcome measurements were made to establish the change in distant visual acuity from the baseline to the 12-month examination. The statistical analyses were carried out on the intent-to-treat principle. RESULTS: The improvement of one or more ETDRS lines was 56% (14/25) of the eyes in the FMT and 16% (4/25) of the eyes in the PDT arm (P = 0.007). Twenty eyes (80%) in the FMT and 16 eyes (64%) in the PDT group had less than three ETDRS lines of vision loss (P = 0.35). Retinal detachment (six eyes) and diplopia (five patients) were recorded in the FMT group. None of the eyes treated in the FMT group had phtysis. CONCLUSION: This pilot study showed that no statistically significant difference existed between the FMT and PDT in terms of the vision loss of less than three ETDRS lines in eyes with neovascular AMD. The chance of vision improvement was significantly higher for the patients in the FMT group. However, in the era of promising therapy with anti-vascular endothelial growth factor for neovascular AMD, FMT should not be offered as a standard primary procedure for neovascular AMD.

The locus of fixation in strabismic amblyopia changes with increasing effort of recognition as assessed by scanning laser ophthalmoscope.

PURPOSE: We performed a qualitative assessment of fixation behaviour in relation to the fovea in patients with strabismic amblyopia. METHODS: The fixation of 25 patients with strabismic amblyopia was examined using a scanning laser ophthalmoscope (SLO). A digital frame grabber board was programmed to scan onto the patient's retina single solid black discs of 5, 10 and 15 degrees in diameter and Landolt Cs in different orientations and corresponding to a visual acuity (VA) of 0.01-0.2 in European decimals. The relative position of the fovea was video-recorded. Fifty video fields per second were plotted as x/y (fixational positions in relation to the fovea) and x/t (motion over time) graphs. RESULTS: Three main groups of patients were seen. Group 1 (n = 6), with a VA of < 0.1, showed a grossly eccentric and unstable locus of fixation independent of size/type of test stimulus used. Group 2 (n = 15), with VA of 0.1-0.8, initially used an eccentric retinal area for fixation that, however, shifted to the fovea with decreasing size and increasing detail of the target for fixation. Group 3 (n = 4), with VA of 0.3-0.8, had stable central fixation throughout. CONCLUSIONS: We speculate that the reduced VA associated with strabismic amblyopia is due to a defective motor control of fixation that can be modulated by recognitional effort.