Surgery for Macular Degeneration: Everything You Need to Know

When it comes to macular degeneration, there are some unique surgical options to consider. From laser photocoagulation, which destroys new blood vessels, to photodynamic therapy, submacular surgery, anti-VEGF injections, retinal translocation, and more, here's what to know about macular degeneration surgery and how it can help to preserve vision.

What Is Macular Degeneration Surgery?

There are a variety of possible approaches to macular degeneration that may prove helpful. For the most part, these target wet macular degeneration, in which there is a proliferation of abnormal new blood vessels. But in some instances these are useful in late macular degeneration cases regardless of the type. Here's what to know.

Anti-VEGF Injections

By blocking the signal that spurs new blood vessels to grow, these injections, known as anti-VEGF (vascular endothelial growth factor), are used to slow progression of wet macular degeneration, keeping these blood vessels from forming. Since the approach is preventative, this is usually a first-line treatment. The idea is to preserve remaining vision.

Contraindications

These are not for everyone with wet macular degeneration and should not be used by:

• Those allergic to any component of this medication
• Anyone with an eye infection or a severe general infection
• People who are pregnant, trying to get pregnant, or breastfeeding
• Anyone who has had a stroke in the past six months should use this cautiously.
• Anyone with uncontrolled high blood pressure or angina should proceed with caution.

Potential Risks

While anti-VEGF injections do have risks, these tend to be rare. They can include the following:

• Serious infection, found in just 1 in 1,000 cases
• Detached retina (the light-detecting layer at the back of the eye comes loose)
• Bleeding and clotting in the eye
• Development of cataract (clouding of the lens)
• Development of inflammation in the eye
• Elevation of eye pressure
  

During the Procedure

This is typically done at your doctor's office. For the procedure, you will be comfortably lying faceup. Your doctor will administer numbing drops, and then a device will be placed in your eye to keep it open during the procedure.

With the injection itself, you should feel nothing but a little pressure. Don't be alarmed if you see a web of lines as the medicine mixes with fluids in your eye—this happens in some cases.

After the Procedure

Once the injection is finished, you'll likely be prescribed antibiotic drops to take for the next few days. If you feel any soreness, you may be advised to take Tylenol or Advil or to apply a cool cloth on your closed lid for up to 10 minutes every half hour. You will likely have to come back for additional injections every four to six weeks for a set amount of time.

Photodynamic Therapy

Photodynamic therapy involves the use of a special light-sensitive dye used together with a low-powered laser to destroy new abnormal blood vessels.

With the approach, the dye is injected into your arm and allowed to circulate to your eyes. In the eye, this collects in the leaky abnormal blood vessels. Once the laser light is aimed into the eye, this activates the medicine, which forms tiny clots, and the unwanted blood vessels are destroyed.

Contraindications

Photodynamic therapy is not used for dry macular degeneration.

Potential Risks

While this is a targeted therapy, there still can be risks. These include:

• Injection-related pain
• Back pain associated with the light-activated medicine
• New blind spots
• A sunburn-like reaction in cases of sunlight exposure after treatment
• Visual blurring temporarily

During the Procedure

This is also an outpatient procedure. When you come in, you'll be given drops to dilate your eyes (open the iris fully). Your eyes will be numbed so you don't feel anything. You may also be given medicine to help you relax.

A light-sensitive medicine will be injected into your body. The doctor will place a special contact lens on your eye to focus the laser on the right spot on the retina. The laser will then be aimed at your eye, where it will activate the light-sensitive medicine to seal off leaking blood vessels. The doctor will then cover your eye.

After the Procedure

Make sure you ask someone to come with you so they can drive you home shortly after the procedure. Keep in mind that because of the light-sensitive medication, you'll need to avoid the sun and should stay indoors for a few days. If you must venture out, you should wear protective clothing and sunglasses.

Laser Photocoagulation

The idea with this technique is to use a laser beam to destroy unwanted new blood vessels before they can leak onto the macula and cause damage to cells there. While this can't cure macular degeneration, it can help to preserve some remaining vision. But it is not without risk and can in the process lead to some vision loss in some cases.

Because it can also destroy healthy tissue when treating leaky vessels, this is very carefully used in limited situations where new blood vessels are not in the center of the vision. While this was one of the only options early on for treating leaking blood vessels, it has fallen out of favor in many cases since the advent of more targeted approaches.

Contraindications

This is an option only for those with wet macular degeneration. It is contraindicated, or typically advised against, for:

• Those with dry macular degeneration
• Those with blood vessels clumped together in the central part of the retina
• Those with blood vessels that are widely scattered
  

Potential Risks

Like any procedure, this can have risks. These include:

• Eye bleeding
• A worse blind spot developing due to accidental treatment of the central macula (the oval area in the center of the retina that provides straight-ahead vision)
• Scarring from the laser damaging the retina, either immediately or years down the road

During the Procedure

When you come in for this outpatient procedure, you'll be given drops to numb your eyes and dilate the pupils. You'll be seated in a chair for the procedure. Because your eyes are numb, when the pulses are directed at your eye, you'll feel minimal discomfort. It will take about 30 minutes for the procedure to be complete.

After the Procedure

Once the procedure is over, you should be able to leave soon after. However, expect your vision to be blurry for the first day. You may also initially see strands in your visual field known as floaters, but these will go away over time.

Submacular Surgery

The idea here is to surgically remove abnormal blood vessels, as well as any blood below the macula. So far results here have been extremely limited. The Submacular Surgery Trials funded by the National Eye Institute showed that there was no improvement in vision or in stability after the procedure. However, there is no telling how you might respond since each case is unique.

Retinal Translocation

This involves detaching the central fovea (a tiny divot inside the macula responsible for the finest vision) from the damaged portion of the retina in someone with advanced macular degeneration and relocating it to a healthier part of this tissue.

The results of this treatment are quite varied, with some noticing an improvement and others seeing their vision fail to improve or even decline.

Contraindications

This procedure can't be done if there isn't enough healthy retina.

Potential Risks

Risks include:

• Vision worsening
• Retinal detachment
• Bleeding
• Seeing double
• Some visual tilting
  

Implantable Miniature Telescope

This tiny device, which is implanted in just one eye in place of a traditional lens during cataract surgery, is for those with late macular degeneration, The device is used to magnify images on the healthy part of the retina to at least double the size and thereby provide more useful central vision for patients.

Because the image is enlarged by the implantable miniature telescope, more of the intact parts of the retina can recognize it.

Contraindications

Undergoing placement of the implantable miniature telescope is contraindicated for:

• Those who have had prior cataract surgery in the eye
• Those with optic nerve disorders
• Anyone with pseudoexfoliation syndrome, where there can be a buildup of tiny deposits in the body
• Anyone with any conditions that may compromise peripheral vision in the fellow eye

Potential Risks

Risks include:

• Corneal endothelial cell loss (the single cell layer on the inside of the cornea, which is the clear dome over the front of the eye)
• Inflammatory deposits

Purpose of Macular Degeneration Surgery

The reason for undergoing macular degeneration surgery depends upon the specific procedure.

Laser photocoagulation and photodynamic therapy both use lasers to destroy abnormal new blood vessels. However, they go about this differently. Laser photocoagulation directly destroys the blood vessels, while photodynamic therapy uses light-activated dye to form tiny clots that then destroy the blood vessels in a targeted way.

Meanwhile, anti-VEGF injections block vascular endothelial growth factor, which otherwise would spur the development of these abnormal blood vessels. Submacular surgery removes the abnormal blood vessels before they can leak blood onto the retina and cause damage there.

Retinal translocation and placement of an implantable miniature telescope aim to maximize vision for those with advanced macular degeneration.

How to Prepare

If you are scheduled for one of these macular degeneration procedures, check with your doctor to find out exactly what the protocol is at your facility. But here's an idea of what to expect.

Location

With the exception of retinal translocation, these eye surgeries are usually outpatient procedures that take place in either a doctor's office or an outpatient facility.

What to Wear

With this kind of outpatient eye procedure, the surgeon may have certain stipulations, but in general, the idea is to wear loose-fitting clothing that you can easily relax in and that won't pinch or distract you.

You should avoid wearing contact lenses or any makeup that can contaminate the area. Likewise, avoid using any skin lotions on your face.

Food and Drink

In many cases, these procedures will be done under local anesthetic, where just the eye is numbed. Still, you may be asked to avoid eating.

In some instances, these procedures may need to be performed under general anesthesia and will have food restrictions beforehand. Also, expect any more involved surgery such as retinal translocation surgery to be performed under general anesthesia.

Medications

Prior to the surgery, your doctor may give you antibiotic drops, as well as nonsteroidal anti-inflammatory agents to make sure any brewing infection or building inflammation doesn't interfere with your recovery.

What to Bring

Be sure to bring your insurance card with you on the day of the surgery, as well as any other paperwork you've been asked to fill out preoperatively. Also, have someone available to drive you home since your eyes will be dilated and you will likely be unable to see clearly.

Recovery

Talk with your eye doctor about what to expect in recovery, as it varies by procedure. Your doctor will inform you as to what follow-up appointments are needed. Your vision will be blurry for a couple of days. Do not drive until your vision has cleared.

With some procedures, such as anti-VEGF injections and laser photocoagulation, you may have some eye soreness for a day or more.

If you have had photodynamic therapy, it is important to stay out of direct sunlight for two to five days. You will also need to protect your eyes from sunlight during that time.

Summary

Surgery for those with wet macular degeneration can help to preserve vision in some for a longer period. In the case of intravitreal injections, they can help keep abnormal blood vessels from forming. Different techniques can destroy leaking blood vessels, while others can help to maximize vision.

A Word From Verywell

If you are dealing with macular degeneration, the good news is that there have never been more surgical options than there are today. These can not only help to preserve vision but, in some instances, work to maximize the vision you have. Be sure to check with your practitioner to determine which is ultimately best for you.