Abstract
Abstract: :
Purpose: To evaluate the functional and anatomical outcome 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. Design: Prospective non–randomized study in 47 patients (50 eyes) with ARMD with a follow–up of 3–6 months. Methods: All eyes had visual loss due to age–related macular degeneration. 11 eyes with classic membranes, 23 eyes with occult membranes, 2 with mixed membranes, 8 eyes with vascularized PED were included. 4 eyes had areolar atrophy without CNV membranes. 2 eyes showed exsudative ARMD with acute bleeding. After the extraction of the neovascular complex, an autologous peripheral full–thickness patch of retinal pigment epithelium, Bruch's membrane, choriocapillary, and choroid was cut out from the midperiphery and repositioned under the macula. Endotamponade was achieved using SF6 or silicone–oil. Functional tests included ETDRS vision testing and reading function (Radner Test). Fluorescein and ICG angiography, autofluorescence and OCT testing was performed to evaluate the anatomical outcome. Results: Preoperative visual acuity ranged from 20/800 to 20/40. Reading vision ranged from 1.4 (LogRAD) to 0.4 (LogRAD). In 5 eyes postoperative subretinal bleeding occurred, revision surgery was required in 11 eyes. 5 eyes suffered from re–detachment and PVR. 3 months postoperative vision ranged from 20/800 to 20/40, with an increase of 15 letters in 6 eyes. Visual outcome was not related to the type of ARMD. Revascularization was visible on fluorescein and ICG angiography in 49 of 50 eyes. Vascularization of the graft was correlated to autofluorescence of the pigment epithelium. Conclusions: The translocation of a full–thickness patch with autologous peripheral retinal pigment epithelium to the macula after choroidal neovascular membrane extraction may result in a surviving and functioning graft. Interestingly, vascularization of the graft with some function was achieved even in patients with geographic atrophy. Long–term follow–up has to demonstrate risks for subsequent graft fibrosis and long–term survival of the graft.
Keywords: choroid: neovascularization • retinal pigment epithelium • vitreoretinal surgery