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Laura Bertazzi, Matteo G. Cereda, Barbara Parolini, Antonio Polito, Andrea Giani, Grazia Pertile; Prospective Study: OCT-selected Patients Undergoing Retinal Pigment Epithelium - Choroid Transplantation For Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2011;52(14):140.
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To evaluate the clinical course and retinal anatomical changes in Spectral-Domain OCT (SD-OCT) selected eyes of AMD patients who underwent RPE-choroid (PATCH) transplantation.
Prospective observational case series of 8 patients with AMD undergoing a RPE-choroid transplantation. SD-OCT, autofluorescence (AF) and fluorescein angiography (FA) combined with indocyanine green angiography (ICGA) examinations were obtained using Spectralis HRA+OCT (Heidelberg Engineering, Heidelberg, Germany) before surgery and at 1, 2, 3, and 6 months after surgery. Revascularization of the patch was assessed for the presence of early fluorescence by FA and for perfusion of choroidal vessels by ICGA. Morphologic characteristics of the retina and of the PATCH underneath were evaluated on high-resolution OCT images.
All the eyes showed pre-surgical presence of external limiting membrane (ELM) and outer nuclear layer (ONL) in the fovea. In 5 eyes the inner-outer segment junction (IS-OS) was evident. Visual Acuity (VA) improved in 6 patient. These patients showed complete patch revascularization within 30 days. All these eyes had identifiable ELM and ONL at 1 month’s examination. None of these patients showed visible IS-OS. ELM and ONL presence was maintained at 6 months, becoming progressively more defined. IS-OS appeared in 2 eyes at 2 months, it was present in 3 eyes at 3 months, and 4 eyes at 6 months. As the retinal outer layer became visible on OCT, it was always maintained in the next exams. VA was correlated with ELM and ONL presence, and markedly improved when IS-OS appeared. 2 cases, both with good pre-surgical retinal characteristics, were unsuccessful: one patch did not show revascularization, and central retinal as well as patch became gradually thinner; the other patch showed revascularization in 20 days. In this patient ELM and ONL became progressively more visible and thicker, but VA did not improve. Moreover, IS-OS was present before surgery but did not show up in the following 6 months. This event was observed even in 2 of the VA improvement cases. Nevertheless, in the non-improved patient we observed a progressively loss of the foveal hypoautofluorescence, as a possible sign of macular pigment loss.
Successful surgery outcomes after RPE-choroid transplantation are associated with the presence of specific outer retinal features in SD-OCT post-operative images.
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