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J.C. Van Meurs, G. Vijfvinkel, T. Misotten, B. Kirchhof, P. Mulder, H. Heimann, A. Joussen, K. Maaijwee; The Translocation of an Autologous Retinal Pigment Epithelium and Choroid Graft in Patients With Exudative Macular Degeneration: Visual Results . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2692.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the visual outcome after one and two years of autologous midperipheral retinal pigment epithelium translocation following the removal of a subfoveal choroidal neovascularization in patients with exudative age–related macular degeneration (ARMD) and to identify preoperative factors that correlate with vision after one year.
In 58 consecutive patients best corrected ETDRS vision was measured preoperatively and at one (n=58) and two years (19 of 58) postoperatively and converted to LogMAR. 52 of these patients had pre–operative imaging (colour fundus, FLU and ICG). The correlations between preop. vision, lesion type (predominantly or minimally classic, occult or haemorrhagic), size (in disc areas) of the lesion, size of subretinal hemorrhage, duration of visual loss and ETDRS vision at 12 months were tested with uni– and multivariate analysis.
Mean pre–operative VA was 0,96 LogMAR, and 0,90 and 0,77 LogMAR after 1 and 2 years respectively, i.e. moderate gain in vision on average. Preop. vision was 20/80 in 2 patients and 20/80 or better in 14 after 1 year and in 4 after 2 years. The duration of visual loss ranged from 11 months to 3 weeks, with a median of 5 weeks. Univariate analysis showed an inverse relation between duration of visual loss and vision at 12 months. In patients with a visual loss of less than 5 weeks duration the size of the lesion and the size of hemorrhage were inversily related to vision at 12 months. Multivariate analysis, however, failed to confirm these associations.
Postoperative complications included retinal detachment with PVR in 4 patients, suprachoroidal hemorrhage in 1 patient and a recurrent or persistent choroidal neovascularization in 9 patients.
An autologous RPE translocation results on average in stabilization of the patients’ vision, as well as in a vision of 20/80 or more in 24% and 21% after 1 and 2 years resp. No preoperative factors were identified for a better patient selection, possibly due to other variables, such as peroperative ones (because of the current sub–optimal technique) and postoperative complications. We speculate that a fool–proof tool to insert the free graft may improve visual outcome.
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