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S. A. Alpatov, A. G. Chtchouko, V. V. Malishev; Autologous Free RPE and Choroid Graft Transplantation With 180° Retinotomy in Patients With Exudative AMD. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5089.
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© ARVO (1962-2015); The Authors (2016-present)
To study the efficacy of surgical removal of subfoveal choroidal neovascular membrane (CNM) with subsequent transplantation of autologous midperipheral full-thickness graft of retinal pigment epithelium (RPE) and choroid into submacular space in patients with exudative age-related macular degeneration (AMD).
Surgical treatment was performed on 5 eyes of 5 patients with exudative AMD more than 3 DD (group A). Surgery included phacoemulsification, IOL implantation, 3-port vitrectomy, formation of local retinal detachment, and 180° peripheral retinotomy with CNM removal. Full-thickness RPE/Choroid complex was isolated from the inferior quadrant and transferred into the submacular space. Retina was reattached. Tamponade with silicone oil concluded the surgery. Silicon oil was removed three months after surgery. For comparison, a retrospective analysis of outcomes of surgical treatment of 17 patients with exudative ARMD more then 3 DD (group B) was performed. Surgical treatment included standard 3-port vitrectomy, central retinotomy with CNM removal, and air tamponade in the conclusion of the procedure. All patients were followed for 24 months with Optical Coherence Tomography, fluorescent angiography (FA), visometry, and fixation test.
In group A, the transplant was stable though slightly reduced in size in all patients. 3 patients showed gray fibrotic line over the graft. Visual acuity did not change in 3 patients, insignificant improvement of vision occurred in 1 patient, and visual acuity decreased 1 patient due to retinal detachment. Fixation was perigraftal in all cases. In group B, fundus biomicroscopy and FA demonstrated marked atrophy at the area of removed CNV. Visual acuity improved in 6 patients, did not change in 9, and decreased in 2. In 5 patients fixation corresponded to the atrophic area.
180° peripheral retinotomy allowed for implantation of relatively large graft with least traumatizing and maximal preservation of macular retina. Removal of CNV is an established technique and can stabilize vision in some patients with exudative AMD. Free RPE graft with 180° retinotomy still represented a complicated operation and its functional result comparable with simple removing of CNV.
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