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N.F. Fawzy, S. Joeres, H. Llacer, F.M. A. Heussen, B. Kirchhof, A.M. Joussen; Autologous Translocation of the Choroid and RPE in Age Related Macular Degeneration – 1 Year Follow–Up in 25 Patients . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2191.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the long–term functional and anatomical outcome of autologous translocation of peripheral choroid and RPE (Patch) in patients with age–related macular degeneration. DESIGN: prospective non–randomized study in 25 patients with AMD with a follow–up of 1 year.
All patients had visual loss due to neovascular age–related macular degeneration. 2 eyes with classic membranes, 11 eyes with occult membranes, 1 eye with mixed membranes, 4 eyes with PED, 2 eyes with rupture of the RPE and 5 eyes with massive subretinal bleeding were included. After the extraction of the neovascular complex, an autologous peripheral full–thickness Patch was positioned under the macula. Functional tests included ETDRS distant vision and reading (Radner Test) and microperimetry (SLO). Fluorescein, ICG angiography and autofluorescence were evaluated prior to patch and at 6 months and 1 year follow–up.
Pre–operative visual acuity ranged from 0.3 to 1.4 (logMAR). One year post–operative vision ranged from 0.10 to 2.10, with stabilization (± 1 line) in 5 eyes and an increase of two or more lines in 5 eyes. Decrease of visual acuity was seen in most cases within the first 3 months after surgery and was mainly due to chorioretinal trauma or bleeding in 6 cases, decentration of the patch in 3 cases, intravitreal hemorrhage, lack of vascularization of the graft, epiretinal membrane formation and cataract each in 1 eye. From 3 months to 1 year follow–up, 19 of 25 eyes showed no change (± 1 line) or an increase of visual acuity (mean change from 3 to 12 months: increase of 0.1 logMAR). 5 eyes had cataract or secondary cataract at last examination. In patients who demonstrated vascularization of the graft after 3 months, this persisted up to 12 months. Similarly, there was no difference in autofluorescence of the graft between 6 months and 12 months postoperatively. In patients with stable fixation at 6 months, the stable fixation was maintained up to 12 months. 5 cases showed recurrence of CNV at the edge of the patch at 6 months or one year follow–up visit and were treated with laser coagulation.
Patch translocation results in a long–term viable graft. Postoperative complications including subretinal hemorrhage with developing fibrosis or PVR usually occur within the first 3–6 months during the follow–up. Once vascularization of the graft is established it persists throughout the 12 months observation period. Increase in visual acuity can be seen even from 6 to 12 months follow–up. So far, there is no evidence of graft failure within a 1 year follow–up.
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