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F. K. Chen, G. S. Uppal, R. MacLaren, A. Tufail, G. W. Aylward, L. da Cruz; Long Term Functional and Structural Outcomes of Macular Translocation and Autologous Rpe Choroid Patch Graft for Treatment of Exudative Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4285.
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To describe the two year outcomes of macular translocation with 360 degree retinectomy (MT) and autologous RPE-choroid graft in patients with exudative age-related macular degeneration (AMD)
We retrospectively reviewed the medical charts from the first 12 patients who underwent MT (from May 2003 to April 2005) and the 12 patients who underwent graft (from August 2004 to June 2005). Data on complications, visual acuity (VA), microperimetry (MP) and fundus imaging (colour photographs, angiography, optical coherence tomography, autofluorescence images) were reviewed.
The mean age for the MT and graft groups were 74 and 80 respectively (p = 0.12). A Mann-Whitney U test revealed no significant difference in the baseline VA between the MT group (Median = 0.90, n = 12) and the graft group (Median = 0.87, n = 12), U = 58.5, p = 0.44. At 2 years, 5 and 2 of the 12 eyes each, that underwent MT and graft, respectively, were seeing 20/100 or better. Friedman Test showed that there was a statistically significant reduction in VA across the four time points in the graft group (Χ2 = 14.0, p = 0.03). The median VA deteriorated from baseline (median = 0.87) to 6 months (median = 1.41) and then stabilised between 1 (median = 1.50) and 2 years (median = 1.48). In contrast, the median VA improved slightly and maintained for up to 2 years in the MT group (Χ2 = 6.0, p = 0.11). Serial MP showed persistence of retinal sensitivity and maintainance of fixation stability. Postoperative complications within the first year after initial surgery included retinal detachment, submacular haemorrhage, persistent or recurrent choroidal neovascular membrane (CNV), and proliferative vitreoretinopathy and torsion. A total of 8 and 5 patients required additional intraocular procedures for treatment of postoperative complications In the MT and graft groups respectively. Complications arising during the second or third year, include cystoid macular edema, recurrent CNV and alteration in the autofluorescence pattern in the submacular region.
Overall VA is poor after graft despite re-establishment of photoreceptor-RPE interface. The short and long term visual outcome of MT appears to be superior to that of graft despite similar success rate in anatomical reconstitution or reconstruction of the foveal-RPE-choroid interface.
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