Original article
Autologous Translocation of the Choroid and Retinal Pigment Epithelium in Age-related Macular Degeneration

https://doi.org/10.1016/j.ajo.2006.01.090Get rights and content

Purpose

To evaluate the autologous translocation of peripheral choroid and retinal pigment epithelium (RPE) in 45 eyes of 43 patients with age-related macular degeneration (AMD).

Design

Prospective nonrandomized study.

Methods

All patients had visual loss due to AMD (n = 5 classic membranes, n = 14 occult, n = 2 mixed, n = 16 pigment epithelial detachment (PED), n = 5 subretinal hemorrhage, n = 3 geographic atrophy). After extraction of the neovascular complex, an autologous peripheral full-thickness explant of RPE, Bruch membrane, and choroid was translocated from the midperiphery to the macula.

Results

Preoperative distant visual acuity ranged from 20/800 to 20/40. Reading vision ranged from 1.4 logarithm of reading acuity determination (logRAD) to 0.5 logRAD (0.04 to 0.32 Snellen equivalent). Revision surgery was required in 22 eyes as a result of proliferative vitreoretinopathy (PVR), retinal detachment, macular pucker, or vitreous hemorrhage. In eight patients, the patch was renewed. At six months, distant visual acuity ranged from light perception to 20/50 (increase of 15 letters in four eyes). Reading vision ranged from 1.4 to 0.4 logRAD. Visual outcome was unrelated to the type of AMD. Vascularization of the transplant was visible on indocyanine green (ICG) angiography in 40 of 42 eyes. In most patients, autofluorescence of the pigment epithelium was coincident with revascularization of the graft. Fixation on the patch was positively related to visual acuity.

Conclusions

Autologous translocation of a full-thickness transplant of choroid and RPE usually results in a vascularized and functioning graft. Vascularization was even achieved in patients with geographic atrophy. Fixation stability and microperimetry before the patch translocation may be helpful in selecting patients who will profit from surgery.

Section snippets

Methods

Patients with either subfoveal lesions or geographic atrophy that was the result of AMD were included. After subretinal extraction of the neovascular complex, an autologous peripheral full-thickness explant of RPE, Bruch membrane, and choroid was translocated from the midperiphery to the macula. Surgery was completed with gas or silicone-oil tamponade (Figure 1S and Supplementary Video). In patients with severe cataract,37 phacoemulsification was performed at the time of silicone oil removal.

Results

From March 2004 to December 2004, a total of 43 patients (45 eyes) were enrolled onto the study. Twenty-five patients were women and 18 were men. The mean age was 76 ± nine years. Out of the 45 eyes, five eyes were missed at the three-month follow-up, and five eyes were missed at the six-month follow-up. Among the five patients who missed the six-month examination, four were examined at three months. All patients had visual loss due to AMD. Five eyes with classic membranes, 14 with occult

Discussion

In the current study, we report the six-month follow-up of 45 eyes after patch translocation. The study, which follows up on small case series,35, 36, 45 is, to our knowledge, the first prospective functional and anatomical evaluation of an autologous free graft of RPE and choroid using a technique that might be less prone to PVR compared with the 360° macular rotation in a larger group of patients with AMD. In the long term, patch translocation reduced the chance of visual loss of 15 letters

Antonia M. Joussen, MD, is a consultant vitreo-retinal surgeon at the Center of Ophthalmology, Cologne, Germany. Besides the clinical work, Dr Joussen heads a basic science laboratory with main focus on angiogenesis. After medical school in Bochum, Vienna, and Heidelberg, Dr Joussen received her clinical ophthalmology training at the Universities of Heidelberg and Aachen. From 1999–2001, she carried out a research-fellowship on diabetic retinopathy in Anthony Adamis′s Laboratory at Childrens

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  • Cited by (0)

    Antonia M. Joussen, MD, is a consultant vitreo-retinal surgeon at the Center of Ophthalmology, Cologne, Germany. Besides the clinical work, Dr Joussen heads a basic science laboratory with main focus on angiogenesis. After medical school in Bochum, Vienna, and Heidelberg, Dr Joussen received her clinical ophthalmology training at the Universities of Heidelberg and Aachen. From 1999–2001, she carried out a research-fellowship on diabetic retinopathy in Anthony Adamis′s Laboratory at Childrens Hospital, Harvard Medical School, Boston, Massachusetts.

    Supported in part by the Deutsche Forschungsgemeinschaft (DFG) Jo 324/6-1 und 6-2 (Emmy Noether), Jo 324/4-1, and Ki 743/5-1, and Ki 743/2-1. The Brunnenbusch Stein Stiftung and the Glaser Stiftung sponsored patient related costs and the RetinoVit Stiftung Köln was helpful in funding necessary equipment.

    Supplemental Material and Video available at AJO.com.

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