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A. Caramoy, S. Joeres, E. Menrath, B. Kirchhof; Long Term Follow-Up after Autologous Translocation of RPE and Choroid in Geographic Atrophy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5071.
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To evaluate the long term outcome after autologous translocation of the retinal pigment epithelium (RPE) and choroid in patients with geographic atrophy.
In 10 patients with geographic atrophy, an autologous peripheral full-thickness Patch of RPE, Bruch’s membrane, and choroid was positioned under the macula. Functional tests including ETDRS distant visual acuity and reading performance (Radner Test). The point of fixation was determined using microperimetry (Rodenstock SLO and Nidek MP1). Autofluorescence, Fluorescein and ICG angiography were monitored to evaluate the anatomical outcome.
Pre-operative visual acuity ranged from 20/800 to 20/40 (mean 20/80). Six months postoperative visual acuity ranged from 20/800 to 20/32 (mean 20/125), and 2-3 years postoperative from hand movements to 20/32 (mean 20/200). 3 patients showed fixation on the patch 2 years after surgery, with visual acuity of 20/32 in 2 cases and 20/63 in 1 case. In 4 cases, the patch was positioned outside of the area of fixation, these patients did not use the patch for fixation after surgery. In 2 cases, visual acuity decreased because of pucker formation and retinal detachment within the first 6 months postoperatively. In 1 case, visual acuity decreased because of corneal edema due to glaucoma. In all eyes but 1, revascularization was visible on ICG angiography and persisted during follow-up. Autofluorescence of the RPE was seen in all eyes independent of the revascularization of the graft. Although autofluorescence decreased slightly during follow-up in some eyes, none of the patients showed recurrent RPE atrophy as seen in retinal translocation. Retina overlaying atrophic areas at baseline demonstrated scotomas that persisted after patch grafting.
Long term results suggested that autologous translocation of the RPE and choroid in eyes with geographic atrophy may result in a functioning graft with stable or slightly improved visual acuity even up to 2 years after surgery. Patch surgery did not restore retinal function in the area of geographic atrophy, but may retain central fixation in patients with preoperatively remaining RPE islands.
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