Autologous translocation of the choroid and retinal pigment epithelium in age-related macular degeneration.
OBJECTIVE
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).


METHODS
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.
Joussen
Antonia M
AM
Department of Vitreoretinal Surgery, Center for Ophthalmology, University of Cologne, Cologne, Germany. JoussenA@googlemail.com
Heussen
Florian M A
FM
Joeres
Sandra
S
Llacer
Helene
H
Prinz
Beate
B
Rohrschneider
Klaus
K
Maaijwee
Kristel J M
KJ
van Meurs
Jan
J
Kirchhof
Bernd
B
D000368:Aged; D016570:Bruch Membrane / Q000637:transplantation; D002829:Choroid / Q000098:blood supply / Q000637:transplantation*; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D008268:Macular Degeneration / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D018919:Neovascularization, Physiologic; D010857:Pigment Epithelium of Eye / Q000637:transplantation*; D011183:Postoperative Complications; D011446:Prospective Studies; D012086:Reoperation; D014182:Transplantation, Autologous; D014792:Visual Acuity; D058609:Visual Field Tests; D014794:Visual Fields
D004396:Coloring Agents; D007208:Indocyanine Green