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F.A. Heussen, H. Llacer, K. Rohrschneider, A. Lappas, B. Kirchhof, A.M. Joussen; Fixation Stability After Peripheral Autologous Translocation of the Choroid in Age Related Macular Degeneration (PATCH) . Invest. Ophthalmol. Vis. Sci. 2005;46(13):191.
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Aim: To assess the centre of fixation of peripheral autologous translocation of the choroids and RPE after the removal of a subfoveal choroidal neovascular membrane in patients with age–related macular degeneration (PATCH), and to better predict visual function after treatment using scanning laser ophthalmoscope (SLO) fundus perimetry. Methods: Threshold static perimetry using the scanning laser ophthalmoscope (SLO) was performed in 40 Patients before and 3 months after PATCH. The point of fixation was recorded for each stimulus presentation. Overlays of fluorescein angiographic pictures and fundus perimetry were obtained using image analysis software. After the examination, the mean fixation point (MFP) as well as the standard deviation from the MFP, and the location of fixation with regard to the PATCH were evaluated. Fixation was confirmed using a Fixation cross with indirect funduscopy. Results:Fundus perimetry allowed accurate determination of the centre of fixation. Overlays demonstrated the precise geographic relation of the angiographically detectable margin of the PATCH and the centre of fixation. 18 of the patients had unstable fixation and/or extrafoveal fixation before surgery. Stability of fixation did improve in 11 patients after treatment. Stable fixation was observed in 27 cases even when VA was reduced to < 20/100. Fixation on the patch was related to vascularization, visual acuity and fixation stability prior to surgery. Fixation stability did not change during the follow–up if initially diffuse after surgery. Conclusions: Fixation stability prior to and after PATCH may aid the post–treatment counselling of such patients. Patients with unstable fixation could achieve stable fixation after surgery and stable fixation prior to surgery could be maintained after PATCH in most cases. As is there seems to be a correlation between the quality of fixation prior to surgery compared to afterwards, making it unlikely for patients with extrafoveal and unstable fixation to gain significantly better fixation through PATCH.
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