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K. J. Maaijwee, J. C. van Meurs; The Translocation of an Autologous Free RPE and Choroid Graft: Case Selection and Long-Term Follow-up. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5088.
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To study the long term results of the translocation of a free autologous retinal pigment epithelium (RPE)-choroid graft after removal of a subfoveal choroidal neovascular (CNV) membrane in patients with exudative age-related macular degeneration (AMD) and to determine whether preoperative variables may predict visual outcome at 1 year after surgery.
Participants were patients with exudative AMD with a minimal follow-up of 1 year (n = 84) after surgery. Of this group 50, 25 and 8 patients reached a follow-up of respectively 2, 3 and 4 years. Main outcome measureswere visual acuity (VA), fixation and complication rate. Preoperative fluorescein angiograms were assessed by masked readers for lesion size, size of hemorrhage and lesion composition according to the MPS criteria. Analysis of covariance (ANCOVA) was used to analyze the relationship between lesion composition adjusted for preoperative delay and VA, lesion size, percentage of blood, and visual outcome at one year after surgery.
The mean VA improved slightly at 1 and 2 years (0.89 logMAR, Δ = - 0.06), 3 years (0.83 logMAR, Δ = - 0.12) and 4 years (0.88 logMAR, Δ = - 0.07) after surgery. Five patients had a preoperative VA better than 20/80, compared to 19 out of 84, 6 out of 45, 4 out of 22 and 1 out of 7 after 1, 2, 3 and 4 years respectively. Fixation was located on the graft in 62 (74 %) up to the last examination. Predominantly classic and occult lesions had a significant better prognosis than minimally classic or hemorrhagic (≥ 50% blood) lesions. Retinal detachment occurred in 7 patients; 2 caused by rhegmatogenous detachment and 5 caused by proliferative vitreoretinopathy. In 11 eyes, a recurrent or persisting neovascular membrane was observed.
An autologous free RPE-choroid graft may stabilize or improve vision in patients with exudative AMD up to 4 years after surgery. Predominantly classic and occult lesions are associated with a slightly but significant better visual outcome than minimally classic or hemorrhagic (≥ 50% blood) lesions.
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