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Gernot Roessler, Andreas W. Weinberger, Thalia Hirsch, Niklas Plange, Babac A. Mazinani, Peter Walter; Long-term Outcome Following 270-degree Retinotomy And Autologous Retinal Pigment Epithelium Choroid Graft In Patients With Neovascular Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5842.
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To evaluate functional and anatomical results of autologous retinal pigment epithelium (RPE)-choroid graft in patients with neovascular age-related macular degeneration (AMD)
In 2004 15 patients (mean age 73.82 ± 7.49 years) underwent RPE choroid graft surgery for the treatment of neovascular AMD. Following a 270 degree retinotomy the temporal retina was flipped over the optic nerve head. After removal of the neovascular membrane the graft was prepared, positioned onto the foveal region and the retina was folded back to its original position. Finally, laser photocoagulation was applied to the retinotomy margins and silicone oil was installed as endotamponade. After oil removal between week 6 and 12, follow-up examinations were performed at six months (n=15) and at least one year (n=12, mean 47 ± 20 months) after surgery including visual acuity (VA) testing, ophthalmoscopy, indocyanine green (ICG) angiography and autofluorescence (AF) imaging.
The mean preoperative VA (logMAR) was 1.17 with a mean delay between the diagnosis of neovascular AMD and surgery of about ten months. Eight patients had a history of multiple previous treatments with transpupillary thermotherapy (TTT) and/or photodynamic therapy (PDT). Postoperatively, VA decreased to 1.42 (six months) and 1.59 (final examination), respectively. In one patient we found a complete loss of light perception due to a severe suprachoroidal hemorrhage one month after oil removal. Due to proliferative vitreo-retinopathy (PVR) further surgical interventions were required in seven patients.
At final visit in some patients graft autofluorescence could be detected. Moreover, stabilization of VA was gained in about half of the cases. Possibly, the high incidence of postoperative complications was the main cause for the unfavorable morphological and functional outcome. On the other hand low baseline VA, long delay between diagnosis and surgery as well as the pretreatment with TTT or PDT might be considered as co-factors for VA deterioration.
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