Autologous translocation of the choroid and retinal pigment epithelium in patients with geographic atrophy.
OBJECTIVE
To evaluate the functional and anatomical outcomes of autologous translocation of peripheral choroid and retinal pigment epithelium (RPE) in patients with geographic atrophy.


METHODS
Prospective nonrandomized study.


METHODS
Twelve consecutive patients with geographic atrophy secondary to age-related macular degeneration presenting with recent loss of reading vision.


METHODS
An autologous peripheral full-thickness graft of RPE, Bruch's membrane, and choroid was positioned under the macula in patients with geographic atrophy.


METHODS
Functional tests included Early Treatment Diabetic Retinopathy Study distant vision, reading (Radner Test, measured as logarithm of the reading acuity determination [logRAD]), threshold static perimetry, and determination of the point of fixation. Fluorescein and indocyanine green angiography, autofluorescence, and optical coherence tomography served to evaluate the anatomical outcome in a 6-month follow-up (12 months in 7 patients).


RESULTS
Preoperative visual acuity (VA) ranged from 20/800 to 20/40 (mean, 0.6+/-0.4 logarithm of the minimum angle of resolution), and reading vision from 1.1 to 0.5 logRAD (mean, 0.8+/-0.2). Three patients were unable to read. Six months after surgery, VA ranged from hand movements to 20/32, with an increase of > or =5 letters in 2 eyes. Two patients without reading ability preoperatively were able to read after surgery. Reading was possible in a total of 8 patients after 6 months (1.3-0.4 logRAD). In 7 patients who were observed for 1 year, VA remained stable (+/-1 line) in 5 eyes and decreased in 2 eyes between 6 months' and 1 year's follow-up. In all eyes but 2, revascularization was visible on indocyanine green angiography as early as 3 weeks after surgery. Autofluorescence of the RPE was independent of revascularization of the graft and persisted throughout follow-up. Four eyes had unstable fixation and/or extrafoveal fixation before surgery. Two of these eyes stabilized during follow-up. Areas overlying atrophic areas demonstrated low threshold sensitivities that persisted after translocation of a free graft with only limited recovery. Revisional surgery due to proliferative vitreoretinopathy was required in 5 eyes.


CONCLUSIONS
The translocation of a full-thickness graft usually results in a vascularized and functioning graft in patients with geographic atrophy, although is associated with a high risk of complications and visual loss. Longer follow-up is necessary to learn about the long-term survival and functionality of the graft.
Joussen
Antonia M
AM
Department of Ophthalmology, University of Duesseldorf, Duesseldorf, Germany. Joussena@googlemail.com
Joeres
Sandra
S
Fawzy
Nader
N
Heussen
Florian M A
FM
Llacer
Helene
H
van Meurs
Jan C
JC
Kirchhof
Bernd
B
D000792:Angiography; D001284:Atrophy; D016570:Bruch Membrane / Q000637:transplantation; D002829:Choroid / Q000098:blood supply / Q000637:transplantation*; D018450:Disease Progression; D005453:Fluorescence; D005654:Fundus Oculi; D006801:Humans; D008268:Macular Degeneration / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D010857:Pigment Epithelium of Eye / Q000098:blood supply / Q000503:physiopathology / Q000637:transplantation*; D011183:Postoperative Complications; D011184:Postoperative Period; D011446:Prospective Studies; D011932:Reading; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology / Q000503:physiopathology; D014792:Visual Acuity; D058609:Visual Field Tests; D018630:Vitreoretinopathy, Proliferative / Q000209:etiology / Q000601:surgery