Abstract
Purpose: :
To analyze structural changes of the retina after autologous translocation of choroid and retinal pigment epithelium in patients with age–related macular degeneration using optical coherence tomography.
Design: :
prospective non–randomized study in 30 patients with AMD with a follow–up up to 12 months.
Methods: :
30 eyes of 30 patients with visual loss due to age–related macular degeneration underwent submacular surgery with translocation of an autologous full–thickness graft of retinal pigment epithelium, Bruch's membrane, and choroid. Optical Coherence Tomography was performed prior to surgery and at 3, 6 and 12 months follow–up. In eyes with central fixation, retinal thickness was measured and correlated with visual acuity. In all cases morphological appearance of the retina and the patch were analyzed.
Results: :
Retinal thickness at the point of fixation could be measured in 15 eyes preoperative and in 12 eyes at the 6 months–follow–up. Retinal thickness ranged from 151 to 504 µm preoperative (mean 290±129 µm) and from 111 to 338 µm at the 6 months follow–up (mean 203±82 µm). In 10 cases a nearly physiological shape of the retina was seen at the last follow–up. Only 3 eyes showed subretinal fluid which was due to postoperative fibrosis or macular pucker with traction. Macular hole formation occurred in two eyes. Retinal thickness did not correlate with visual acuity. In most eyes, the highly reflective band of the patch corresponding to retinal pigment epithelium is connected to the surrounding RPE. In few cases, the edge of the patch was not connected or the margin of the patch was wrapped. Other remarkable findings were a hyporeflective window towards the choroid, which was seen in most of the eyes and the presence of two highly reflective bands within the patch. A few weeks postoperative, the patch appeared prominent in most eyes. There was a flattening of the patch during follow up. 17 eyes showed flat appearance of the patch at 6 months follow–up (50–250 µm). In 4 eyes, the graft was very flat (0–50 µm), in 7 eyes prominent (250–400 µm) and in 2 eyes very prominent (>400 µm). Interestingly, most patients did not complain about disturbing metamorphopsia in their daily life, even though the patch was prominent or wrinkled in some cases.
Conclusions: :
OCT has become an important instrument for monitoring retinal changes in patients with AMD before and after treatment. In this study we demonstrate that the patch is integrated into the choroidal–RPE complex and may lead to a normalization of retinal thickness and elimination of subretinal fluid.
Keywords: age-related macular degeneration • imaging/image analysis: clinical • choroid: neovascularization