title: Retinal pigment epithelium and choroid translocation in patients with exudative age-related macular degeneration: long-term results.
abstract: 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.
  
  
  CONCLUSIONS
  An autologous free RPE-choroid graft may stabilize or improve vision in patients with exudative AMD up to 4 years after surgery.
authors.affiliation: Department of Vitreoretinal Surgery, the Rotterdam Eye Hospital, Rotterdam, The Netherlands. kmaaijwee@hotmail.com
authors.forename: Kristel
authors.initials: K
authors.lastname: Maaijwee
authors.forename: Heinrich
authors.initials: H
authors.lastname: Heimann
authors.forename: Tom
authors.initials: T
authors.lastname: Missotten
authors.forename: Paul
authors.initials: P
authors.lastname: Mulder
authors.forename: Antonia
authors.initials: A
authors.lastname: Joussen
authors.forename: Jan
authors.initials: J
authors.lastname: van Meurs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002829:Choroid / Q000637:transplantation*; D020256:Choroidal Neovascularization / Q000503:physiopathology / Q000601:surgery; D005122:Exudates and Transudates; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D008268:Macular Degeneration / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010857:Pigment Epithelium of Eye / Q000637:transplantation*; D011183:Postoperative Complications; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology