TY - JOUR
T1 - Retinal pigment epithelium and choroid translocation in patients with exudative age-related macular degeneration
T2 - long-term results
AU - Maaijwee, Kristel
AU - Heimann, Heinrich
AU - Missotten, Tom
AU - Mulder, Paul
AU - Joussen, Antonia
AU - van Meurs, Jan
PY - 2007/11
Y1 - 2007/11
N2 - BACKGROUND: To study the results of the translocation of a free autologous retinal pigment epithelium (RPE)-choroid graft after removal of a subfoveal choroidal neovascular membrane in patients with exudative age-related macular degeneration (AMD), and to determine whether preoperative variables may predict visual outcome at 1 year after surgery.METHODS: Prospective interventional case series of 84 eyes of 83 consecutive eligible patients with exudative AMD with a minimal follow-up of 1 year after surgery. Of this group, 45, 24 and 11 patients reached a follow-up of respectively 2, 3 and 4 years. Pre- and postoperative evaluation included ETDRS visual acuity (VA), fixation testing and color fundus photography. Preoperative fluorescein angiograms were assessed by masked readers for lesion size, size of hemorrhage and lesion composition according to the MPS criteria. The relationship between lesion composition adjusted for preoperative delay and VA, lesion size, percentage of blood, and visual outcome at 1 year after surgery was analyzed.RESULTS: The mean VA (logMAR) improved slightly at 1 and 2 years (0.89, Delta = -0.06), 3 years (0.79, Delta = -0.16) and 4 years (0.74, Delta = -0.21) after surgery. Five patients had a preoperative VA better than 20/80, compared to 19 out of 84, six out of 45, four out of 24 and two out of 11 after 1, 2, 3 and 4 years respectively. Fixation was located on the graft in 62 patients (74%) up to the last examination. Predominantly classic and occult lesions had a significant better prognosis than minimally classic or hemorrhagic (> or = 50% blood) lesions. Retinal detachment occurred in seven patients; two caused by rhegmatogenous detachment and five caused by proliferative vitreoretinopathy. In 11 eyes, a recurrent or persisting neovascular membrane was observed.CONCLUSION: An autologous free RPE-choroid graft may stabilize or improve vision in patients with exudative AMD up to 4 years after surgery.
AB - BACKGROUND: To study the results of the translocation of a free autologous retinal pigment epithelium (RPE)-choroid graft after removal of a subfoveal choroidal neovascular membrane in patients with exudative age-related macular degeneration (AMD), and to determine whether preoperative variables may predict visual outcome at 1 year after surgery.METHODS: Prospective interventional case series of 84 eyes of 83 consecutive eligible patients with exudative AMD with a minimal follow-up of 1 year after surgery. Of this group, 45, 24 and 11 patients reached a follow-up of respectively 2, 3 and 4 years. Pre- and postoperative evaluation included ETDRS visual acuity (VA), fixation testing and color fundus photography. Preoperative fluorescein angiograms were assessed by masked readers for lesion size, size of hemorrhage and lesion composition according to the MPS criteria. The relationship between lesion composition adjusted for preoperative delay and VA, lesion size, percentage of blood, and visual outcome at 1 year after surgery was analyzed.RESULTS: The mean VA (logMAR) improved slightly at 1 and 2 years (0.89, Delta = -0.06), 3 years (0.79, Delta = -0.16) and 4 years (0.74, Delta = -0.21) after surgery. Five patients had a preoperative VA better than 20/80, compared to 19 out of 84, six out of 45, four out of 24 and two out of 11 after 1, 2, 3 and 4 years respectively. Fixation was located on the graft in 62 patients (74%) up to the last examination. Predominantly classic and occult lesions had a significant better prognosis than minimally classic or hemorrhagic (> or = 50% blood) lesions. Retinal detachment occurred in seven patients; two caused by rhegmatogenous detachment and five caused by proliferative vitreoretinopathy. In 11 eyes, a recurrent or persisting neovascular membrane was observed.CONCLUSION: An autologous free RPE-choroid graft may stabilize or improve vision in patients with exudative AMD up to 4 years after surgery.
KW - Aged
KW - Aged, 80 and over
KW - Choroid/transplantation
KW - Choroidal Neovascularization/physiopathology
KW - Exudates and Transudates
KW - Female
KW - Fluorescein Angiography
KW - Follow-Up Studies
KW - Humans
KW - Intraoperative Complications
KW - Macular Degeneration/physiopathology
KW - Male
KW - Middle Aged
KW - Pigment Epithelium of Eye/transplantation
KW - Postoperative Complications
KW - Tomography, Optical Coherence
KW - Treatment Outcome
KW - Visual Acuity/physiology
KW - Visual Field Tests
KW - Visual Fields/physiology
U2 - 10.1007/s00417-007-0607-4
DO - 10.1007/s00417-007-0607-4
M3 - Article
C2 - 17562066
VL - 245
SP - 1681
EP - 1689
IS - 11
ER -