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F. Treumer, C. Klatt, A. Bunse, J. Roider; Autologous RPE Sheet Transplantation in ARMD. Morphologic and Functional Results . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1436.
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To evaluate functional and morphological outcome of autologous RPE sheet transplantation after the removal of a subfoveal choroidal neovascular membrane in patients with age–related macular degeneration.
RPE sheet transplantation was performed in 11 consecutive patients. Follow–up time was between 3 and 12 months. All patients had severe visual loss due to occult CNV (4), subretinal mass bleeding (3), pigment epithelium detachment (2) or geographic atrophy in combination with occult CNV (2). After the extraction of the neovascular membrane, an autologous patch of retinal pigment epithelium, choriocapillaris and choroid was cut out from the midperiphery and translocated under the macula. Silicon oil was used for endotamponade. Fluorescein and ICG angiography, autofluorescence and OCT was performed for morphologic evaluation. Functional testing included ETDRS vision and microperimetric examination with the Nidek–MP1 microperimeter.
Preoperative visual acuity (logMAR) ranged from 1.4 to 0.9, postoperative from 1.4 to 0.5. Postoperative visual acuity improved in 4 patients (by mean 0.18 logMAR), remained stable in 5 patients and decreased in 2 patients. Microperimetric evaluation showed light increment sensitivity of the sheet area in 6 cases and fixation on the sheet in 4 cases. Revascularisation of the graft was visible on fluorescein and ICG angiography in 9 patients. OCT revealed decreasing mean thickness of the sheet from 291 µm postoperative to 202 µm after 6 months. 8 patients showed no postoperative complications. 1 patient required further surgery because of epiretinal membrane formation and 1 patient because of a retinal detachment. 1 patient developed a chorioretinal anastomosis at the site of sheet explantation.
Autologous RPE sheet transplantation after the extraction of a subfoveal choroidal neovascular membrane may result in a vascularized and functioning graft. Fixation on the graft is possible. In this study an increase in visual acuity is moderate but definitely related to the functioning RPE sheet. The development of a chorioretinal anastomosis at the explantation site is a new finding.
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