Coverage Policy Manual
Policy #: 1998136
Category: Surgery
Initiated: July 1998
Last Review: July 2023
  Macular Translocation
Description:
Translocation of the fovea is performed for macular degeneration.  The movement of the fovea is to an area with healthier pigment epithelium.  The procedure was first reported in 1983 in animals, and reported in humans in 1993.  Early success was followed by complications.  More recently, several technical adaptations have been proposed.
 
The American Academy of Ophthalmology has published an analysis of the available literature on the safety and effectiveness of macular translocation and has stated that additional studies are needed to determine the effectiveness and safety of the procedure (AAO, 2000).
 
 
Policy/
Coverage:
Effective July 2021
Does Not Meet Primary Coverage Criteria Or Is Investigational For Contracts Without Primary Coverage Criteria
 
Macular (or foveal) translocation for macular degeneration of any cause does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness.
 
For members with contracts without primary coverage criteria, macular (or foveal) translocation for macular degeneration of any cause is considered investigational. Investigational services are specific contract exclusions in most member benefit certificates of coverage.
 
Effective Prior to July 2021
 
Macular (or foveal) translocation for macular degeneration of any cause is not covered based on benefit certificate primary coverage criteria that there be scientific evidence of effectiveness.
 
For contracts without primary coverage criteria, macular (or foveal) translocation for macular degeneration of any cause is considered investigational.  Investigational services are an exclusion in the member certificate of coverage.
Rationale:
2008 Update
Review of peer reviewed medical literature through July 2008 provided no information which would change the above coverage policy.
 
2012 Update
A literature search was conducted using the MEDLINE database through May 2012.  There was no new literature identified that would prompt a change in the coverage statement.
 
One prospective, randomized, controlled pilot study was identified. Lüke et al (2009) reported the outcome of BCVA, near visual acuity (NVA), contrast sensitivity (CS) and vision-related quality of life (VRQOL) in patients 2 years after undergoing PDT or FMT for the treatment of neovascular AMD. A total of 50 patients with predominantly classic subfoveal CNV secondary to AMD were randomized to PDT or FMT. Best-corrected visual acuity was determined according a standardized protocol with ETDRS charts; NVA were calculated after testing with SNAB (Swiss National Association of and for the Blind) visual acuity cards; and CS was measured with Pelli-Robson charts. The 39-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25 plus supplement) was performed. Primary end points were the changes of BCVA, NVA, CS and VRQOL at 24-month examination. A stabilisation of BCVA (+0.3 letters) was found in the FMT group, whereas a decrease of more than 12 letters (-12.6 letters) was found in the PDT group (p = 0.052). Mean NVA improved by 7.0 letters in the FMT group and was superior to the PDT group (-9.6 letters, p = 0.036), while mean CS showed a time-dependent decrease in both treatment groups (FMT: -3.3 letters, PDT: -3.8 letters, p = 0.726). Considering the results of the VRQOL scores, the improvement of the subscales scores for general vision (p = 0.015), mental health (p = 0.028) and near activity (p = 0.020) were significantly higher in the FMT group. The authors concluded that FMT can stabilize BCVA and improve NVA over a period of 2 years in patients with subfoveal classic CNV secondary to neovascular AMD, whereas a decrease of BCVA and NVA was found in the PDT group; and CS did not differ between FMT and PDT. A significant increase of VRQOL scores was only found in the FMT group and not in the PDT group. They stated that FMT appears to be a therapeutic approach that can increase visual function resulting in an improvement of patient's VRQOL, but exhibits a higher number of severe complications compared to PDT.
 
The coverage statement is unchanged.
 
2014 Update
A literature search conducted using the MEDLINE database through May 2014 did not reveal any new information that would prompt a change in the coverage statement.
  
2015 Update
A literature search conducted through May 2015 did not reveal any new information that would prompt a change in the coverage statement.  The key identified literature is summarized below.
 
Van Romunde and colleagues investigated the long-term outcome of full macular translocation (FMT) for neovascular age-related macular degeneration (AMD) and to identify predictive factor through a retrospective, uncontrolled case series (van Romunde, 2015). Patients were considered for FMT if they had low vision in the fellow eye and choroidal neovascularization (CNV) along with (1) no response to vascular endothelial growth factor (VEGF) inhibitors, (2) retinal pigment epithelium (RPE) tear, (3) subretinal hemorrhage, (4) foveal scar tissue of recent onset, or (5) CNV before the availability of VEGF inhibitors. From 2004 through 2012, a total of 255 patients underwent FMT. Exclusion criteria were patients younger than 60 years, FMT for disease other than AMD, and a follow-up of less than 12 months. Preoperative, annual, and last distance best-corrected visual acuity (BCVA) were obtained retrospectively from patient files. Complications were recorded using funduscopy, optical coherence tomography, autofluorescence, and angiography. Main outcome measures were distance BCVA at 1 year and 5 years after surgery and at last visit compared with preoperative BCVA. The results were One hundred fifty-eight patients (mean follow-up, 45 months) were included. Median BCVA improved from 0.90 logarithm of the minimum angle of resolution (logMAR) before surgery to 0.70 logMAR 1 year after FMT (2 lines gained; P = 0.000). In a subgroup of 56 patients followed up for 5 years or more, median BCVA improved from 0.95 logMAR before surgery to 0.70 logMAR 1 year after surgery, and remained improved 5 years after FMT with a median BCVA of 0.80 logMAR (1.5 lines gained compared with preoperative BCVA; P = 0.000). The main complications were foveal RPE atrophy (n = 73; 47%) and CNV recurrence (n = 47; 30%). Foveal RPE atrophy (odds ratio [OR], 7.0), CNV recurrence (OR, 2.6), and proliferative vitreoretinopathy (PVR; OR, 17.6) were statistically significant predictors (P < 0.05) for losing 1 line or more at last visit. In this study, BCVA was improved up to 5 years after FMT. Foveal RPE atrophy, CNV recurrence, and PVR carried a worse prognosis. In patients who are unlikely to benefit from VEGF inhibitors, FMT can be considered for second eyes with neovascular AMD.
 
Based on the above referenced literature, the policy coverage remains unchanged.
 
2017 Update
A literature search conducted through June 2017 did not reveal any new information that would prompt a change in the coverage statement.  
 
2018 Update
A literature search was conducted through June 2018.  There was no new information identified that would prompt a change in the coverage statement.  
 
2019 Update
Annual policy review completed with a literature search using the MEDLINE database through June 2019. No new literature was identified that would prompt a change in the coverage statement.
 
2020 Update
A literature search was conducted through June 2020.  There was no new information identified that would prompt a change in the coverage statement.  
 
2021 Update
Annual policy review completed with a literature search using the MEDLINE database through June 2021. No new literature was identified that would prompt a change in the coverage statement.
 
2022 Update
Annual policy review completed with a literature search using the MEDLINE database through June 2022. No new literature was identified that would prompt a change in the coverage statement.
 
2023 Update
Annual policy review completed with a literature search using the MEDLINE database through June 2023. No new literature was identified that would prompt a change in the coverage statement.
CPT/HCPCS:
67299Unlisted procedure, posterior segment
References: Aisenbrey S, Lafaut BA, et al.(2002) Macular translocation with 360 degrees retinotomy for exudative age-related macular degeneration. Arch Ophthalmol 2002; 120:451-9.

Am Academy of Ophthalmology. Macular Translocation. Ophthalmology 2000; 107 :1015-8.

Bressler NM, Hawkins BS, et al.(2001) Are the submacular surgery trials still relevant in an era of photodynamic therapy? Ophthalmology 2001; 108:435.

deJuan E, Lowenstein A, Bressler N, et al.(1998) Translocation of the Retina for Management of Subfoveal Choroidal Neovascularization II. A Preliminary Report in Humans. Am J Ophthal 1998; 125:635-646.

Fujii GY, de Juan E Jr, et al.(2002) Inferior limited macular translocation for subfoveal choroidal neovascularization secondary to age-related macular degeneration: 1-year visual outcome and recurrence report. Am J Ophthal 2002; 134:69-74.

Fujikado T, Ohji M, Sato Y, et al.(1998) Visual Function after Foveal Translocation with Scleral Shortening in Patients with Myopic Neovascular Maculopathy. Am J Ophthal 1998; 125:647-654.

Haller JA, Hartranft CD, Fujii GY, et al.(2000) Limited Macular Translocation for Neovascular Maculopathy. Semin Ophthalmol 2000; 15:81-7.

Hamelin N, Glacet-Bernard A, et al.(2002) Surgical treatment of subfoveal neovascularization in myopia: macular translocation vs surgical removal. Am J Ophthal 2002; 133:530-6.

Lewis H.(2001) Macular Translocation with Chorioscleral Outfolding: A Pilot Clinical Study. Am J Ophthal 2001; 132:156-63.

Luke C, Aisenbrey S, Luke M, et al.(2001) Electrophysiological changes after 360 degrees retinotomy and macular translocation for subfoveal choroidal neovascularization in age related macular degeneration. Br J Ophthal 2001; 85:928-32.

Lüke M, Ziemssen F, Völker M, et al.(2009) Full macular translocation (FMT) versus photodynamic therapy (PDT) with verteporfin in the treatment of neovascular age-related macular degeneration: 2-year results of a prospective, controlled, randomised pilot trial (FMT-PDT). Graefes Arch Clin Exp Ophthalmol. 2009 Jun;247(6):745-54. Epub 2009 Feb 12.

Machemer R.(1998) Macular translocation. An editorial. Am J Ophthal 1998; 125:698-700.

Macular translocation for age-related macular degeneration. National Institute for Clinical Excellence (NICE) 2004.

Mateo C, Moreno J, Rosales G, et al.(2004) Two-year results of macular translocation with scleral infolding in myopic choroidal neovascularisation. Semin Ophthalmol 2004;19(1-2):29-42.

Pawlak D, Glacet-Bernard A, Papp M, et al.(2004) Limited macular translocation compared with photodynamic therapy in the management of subfoveal choroidal neovascularization in age-related macular degeneration. Am J Ophthal 2004; 137(5):880-7.

van Romunde SH, Polito A, Bertazzi L, et al.(2015) Long-Term Results of Full Macular Translocation for Choroidal Neovascularization in Age-Related Macular Degeneration. Ophthalmology. 2015 Apr 13. pii: S0161-6420(15)00252-3.

Vander JF.(2000) Macular Translocation. Curr Opin Ophthalmol 2000; 11:159-65.
Group specific policy will supersede this policy when applicable. This policy does not apply to the Wal-Mart Associates Group Health Plan participants or to the Tyson Group Health Plan participants.
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