Retinal pigment epithelium translocation after choroidal neovascular membrane removal in age-related macular degeneration.
OBJECTIVE
To test the feasibility of a new surgical technique and to assess visual function over the translocated retinal pigment epithelium (RPE) cells in patients operated on for subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (ARMD).


METHODS
Retrospective, noncomparative, interventional case series.


METHODS
Nine patients with previously untreated exudative ARMD underwent surgical excision of the subfoveal CNV with RPE translocation and were observed for 12 to 32 months.


METHODS
The surgery consisted of a standard three-port pars plana vitrectomy, excision of the CNV, and RPE translocation. Pre- and postoperative ocular examination included best-corrected visual acuity measurement, fundus color stereo photography, and fundus fluorescein angiography. Optical coherence tomography and confocal laser scanning ophthalmoscopy (cLSO) were performed after surgery. A crossfixation target and a single-point flashing light were projected on different areas of the posterior pole using a cLSO. Photopic 10 to 2 perimetry, photopic fine matrix mapping, and cLSO microperimetry were also performed after surgery in six patients.


METHODS
Optical coherence tomography cross-sectional scans and cLSO RPE autofluorescence were recorded to detect the presence of viable translocated RPE. Visual acuity, fixation, photopic 10 to 2 perimetry, photopic fine matrix mapping, and cLSO microperimetry were used to test central visual function.


RESULTS
Retinal pigment epithelium was translocated successfully at the time of CNV removal from the edge of the RPE defect to a subfoveal location in seven of nine patients. One patient experienced proliferative vitreoretinopathy, but significant hemorrhage was not a feature. Optical coherence tomography showed the translocated RPE as an area of increased optical reflectivity with optical shadowing external to it. Confocal laser scanning ophthalmoscopy showed autofluorescence of the translocated RPE. The crossfixation target was seen when projected on the translocated RPE. During eccentric fixation, the patients could see a flashing point-target projected on the translocated RPE. Photopic 10 to 2 perimetry, photopic fine-matrix mapping, and cLSO microperimetry showed the presence of central visual function.


CONCLUSIONS
The authors propose that translocation of RPE at the time of CNV removal, from the edge of the RPE defect to a subfoveal location, may have a role in the surgical management of ARMD.
Stanga
Paulo E
PE
The Institute of Ophthalmology, University College London, England UK.
Kychenthal
Andres
A
Fitzke
Frederick W
FW
Halfyard
Anthony S
AS
Chan
Roger
R
Bird
Alan C
AC
Aylward
George W
GW
D000368:Aged; D000369:Aged, 80 and over; D017690:Cell Transplantation; D020256:Choroidal Neovascularization / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008268:Macular Degeneration / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D013508:Ophthalmologic Surgical Procedures; D009887:Ophthalmoscopy; D010781:Photography; D010857:Pigment Epithelium of Eye / Q000637:transplantation*; D014054:Tomography; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014821:Vitrectomy