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T. Stappler, V. Borgioli, H. Heimann, D. Wong; Autofluorescence Findings in 360° Macular Translocation. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4550.
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We report our observation of patterns of increased autofluorescence in the new foveal location following 360° macular translocation surgery for age-related macular degeneration.The aim of this study is to investigate whether these findings can be correlated to preoperative findings and whether they have a predictive value for visual prognosis or case selection.
We present the results of a surveillance study of 90 consecutive patients who underwent 360° macular relocation surgery between December 2000 and June 2005. We report the results of 143 pre- and postoperative autofluorescence episodes using the Heidelberg HRA scanning laser ophthalmoscope operating at a wavelength of 488nm. Greatest linear diameter (GLD) - measurements of the lesion sizes were obtained using the callipers offered by the Heidelberg and Visupac software. Visual acuity measurements were recorded according to TAP-study protocol.
We identified two types of autofluorescence: 1: A paracentral halo, i.e. an area of well demarcated, even hyperfluorescence was observed in 44(49%) of 90 cases. 2: A central focal lesion, characterised by a spotty appearance of hyper and hypofluorescence was observed in 49(54%) of the 90 cases. Its sizes were static and persisted until 4 years postoperatively. No correlation could be found with either preoperative lesion size on fluorescein angiogram, preoperative distribution of subretinal fluid or the development of postoperative cystoid macular oedema. The patients’ vision was not affected.Discussion:We suggest that changes in the previously healthy RPE may be induced by already damaged photoreceptors prior to surgery. Increased autofluorescence indicates increased shedding of photoreceptor outer segments leading to increased ingestion of lipofuscin in the RPE-layer. This is only revealed after macular translocation. In our view, these findings reinforce our view of a multifactorial pathogenesis of ARMD that includes retinal influences in addition to the established RPE-disease. We could not identify any evidence to suggest that preoperative or postoperative autofluorescence was linked to long-term visual outcome.
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