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Francisco A. Folgar, Ramiro S. Maldonado, Neeru Sarin, Cynthia A. Toth; Variations In Photoreceptor-RPE Morphology And Function Are Manifest In Distinct Fundus Autofluorescence Patterns After Macular Translocation Surgery For Advanced AMD. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2687.
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In patients with advanced age-related macular degeneration (AMD), macular translocation surgery with 360° retinectomy (MT360) rotates the fovea and places diseased photoreceptors (PRs) over a new bed of retinal pigment epithelium (RPE). With the unique in vivo model of MT360, we sought to characterize the RPE response to diseased PRs by correlating patterns of fundus autofluorescence (FAF) with spectral domain optical coherence tomography (SDOCT) and visual acuity (VA).
This retrospective consecutive case series enrolled all eyes with FAF imaging after undergoing MT360 for advanced neovascular and non-neovascular AMD from 1999 to 2009 at a university medical center. Postoperative foveal FAF patterns were compared by distribution at follow-up intervals, VA outcome, and distinguishing SDOCT features. The association of FAF and SDOCT, before and after MT360, was evaluated in a subgroup of eyes with available preoperative FAF.
Eighty-four eyes (84 patients) with FAF after MT360 were enrolled, and a subgroup of 24 eyes also had FAF before MT360. Mean follow-up period was 58±33 months. Over long-term follow-up, 19 eyes (22.6%) had foveal hypofluorescence and 7 eyes (8.3%) had mixed autofluorescence patterns, both associated with non-significant postoperative VA change (-0.11±0.09 and -0.0±0.02 delta logMAR, p=0.31 and p=1.0) and the following SDOCT features: severe outer nuclear layer (ONL) thinning, loss of the external limiting membrane (ELM) and inner segment (IS) bands, RPE atrophy, and increased choroidal reflectivity. Forty-five eyes (53.6%) had uniform hyperfluorescence and 13 eyes (15.5%) had petaloid hyperfluorescence patterns, both correlated with significantly improved VA after surgery (-0.18±0.4 and -0.16±0.02 delta logMAR, p=0.012 and p=0.037) and the following SDOCT features: mild ONL thinning, loss of IS band but preserved ELM band, and intact RPE. Petaloid hyperfluorescence had high specificity for postoperative cystoid macular edema of the inner retinal layers.
After MT360 for advanced AMD, aberrant FAF patterns suggest that signaling from translocated PRs can have variable effect on the recipient RPE, which may proceed to an atrophic hypofluorescent state without significant VA improvement or a chronic hyperfluorescent state associated with significantly improved visual function.
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