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B. Kirchhof, S. Joeres, N. Fawzy, F.M. A. Heussen, B. Prinz, A.M. Joussen; Autologous Translocation of the Choroid and RPE in Patients With Geographic Atrophy . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2691.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the functional and anatomical outcome of autologous translocation of peripheral choroid and RPE (Patch) in patients with geographic atrophy.
Prospective non–randomized study in 18 patients with AMD with a follow–up of > 6 months in 11 patients.
All patients had visual loss due to geographic atrophy related to age–related macular degeneration. An autologous peripheral full–thickness Patch of retinal pigment epithelium, Bruch's membrane, and choroid was positioned under the macula. Functional tests included ETDRS distant vision, reading (Radner Test), and threshold static perimetry using the scanning laser ophthalmoscope (SLO). The point of fixation was determined. Autofluorescence, Fluorescein and ICG angiography were monitored to evaluate the anatomical outcome.
Pre–operative visual acuity ranged from 20/800 to 20/32 (logMAR). Reading vision ranged from no reading vision to 0.3 (logRAD). Revisional surgery due to PVR was required in 7 eyes. Three months post–operative vision ranged from 20/800 to 20/63, six months postoperative vision ranged from counting fingers to 20/32 with an increase of 2 lines in 2 eyes. In all eyes but 2, revascularization was visible on ICG angiography as early as 3 weeks after surgery. In one of these cases vascularization slowly appeared after 3 months. Autofluorescence of the pigment epithelium was seen in all eyes independent of the revascularization of the graft and persisted throughout the follow–up. 6 eyes had unstable fixation and/or extrafoveal fixation before surgery. 2 eyes with preoperative unstable fixation showed predominantly stable fixation at last follow–up. All eyes with preoperative stable or predominantly stable fixation were stable or predominantly stable at last follow–up. In cases with preoperative fixation on a central RPE peninsula, fixation remained at this position throughout the follow–up. Retina overlaying atrophic areas demonstrated relative scotoma that persisted after Patch grafting with only limited recovery. In none of the patients a recurrent RPE atrophy on the patch was observed during the follow–up.
The translocation of a full–thickness Patch usually results in a vascularized and functioning graft in patients with geographic atrophy. A longer follow–up is necessary to learn about the long–term survival and functionality of the graft.
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