Submacular surgery versus anti-VEGF for retinal pigment epithelial tear in neovascular age-related macular degeneration.

Abstract

Purpose: To compare the visual and anatomical outcome of full macular translocation (FMT), autologous transplant of retinal pigment epithelium (RPE) and choroid patch graft (PG) and anti-VEGF injections in patients with RPE tear secondary to neovascular age-related macular degeneration (AMD).

Methods: Patients with an RPE tear associated with AMD and a follow-up of ≥6 months were included. Medical records and images were retrospectively reviewed. Best corrected visual acuity (BCVA) was converted into logMAR for analysis. SPSS version 19 was used for the Wilcoxon test and Kruskal Wallis test. A P-value of <0.05 was considered statistically significant.

Results: 46 patients were included: 28 patients (61%) underwent FMT (mean follow-up = 39 months), 11 patients (24%) underwent PG (mean follow-up = 30 months) and 7 patients (15%) were treated with anti-VEGF (mean follow-up = 33 months). Patients treated with FMT improved significantly from a median BCVA of 0.60 logMAR at baseline to 0.50 logMAR at 6 months and remained table until last visit (P = 0.037). Although 28% had a ≥3 line gain, median BCVA of patients that underwent PG changed from 0.60 logMAR at baseline to 0.80 logMAR at 6 months and 1.30 logMAR at last visit (P = 0.362). Median BCVA of patients treated with anti-VEGF decreased significantly from 0.25 logMAR at baseline to 0.30 logMAR at 6 months and 0.60 logMAR at last visit (P = 0.046). The change of BCVA between baseline and last visit were significantly different between the treatment groups (P = 0.009).

Conclusions: Our results suggest that FMT may be an effective treatment to restore and maintain visual function after an RPE tear in AMD patients. Anti-VEGF therapy is rather associated with a visual decline in the long term. The visual outcome of PG on the other hand has a quite variable course.