title: Influence of intraoperative course on visual outcome after an RPE-choroid translocation.
abstract: OBJECTIVE
  In a previous study, preoperative variables were correlated with postoperative visual outcome after the translocation of a free RPE-choroid graft. The present study was conducted to investigate whether the intraoperative course was an independent factor influencing visual outcome in these patients.
  
  
  METHODS
  This was a prospective interventional case series of 48 patients with exudative AMD treated with an RPE-choroid translocation. Preoperative and postoperative evaluation included ETDRS visual acuity (VA) and fixation testing by a masked examiner. Four critical surgical steps were evaluated, and the intraoperative course was graded from 0 (uncomplicated surgery) to 5 (most complicated surgery). The relationship between intraoperative course adjusted for preoperative delay/lesion composition and visual outcome at 3 months and 1 year after surgery was analyzed with multivariate analysis.
  
  
  RESULTS
  The mean VA (logMAR) improved slightly from 0.99 before surgery to 1.00, 0.94, 0.89, and 0.91 after 3, 6, 9, and 12 months, respectively. Foveal fixation on the graft was present in 34 (71%) of the eyes at 1 year after surgery. The intraoperative course was statistically significantly associated with the DeltaVA (logMAR) at 3 months (P = 0.037) and at 1 year after surgery (P = 0.020) and if measured as gain or loss of > or =2 ETDRS-lines (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.7 to 2.8, P = 0.027) and > or =3 ETDRS lines (OR, 2.2, 95% CI 1.9-3.5, P = 0.003); better surgery was associated with visual gain whereas eventful surgery was associated with visual loss.
  
  
  CONCLUSIONS
  The intraoperative course adjusted for preoperative variables had a statistically significant influence on postoperative visual outcomes in patients treated with a free RPE-choroid translocation. Refining the surgery could improve results.
authors.affiliation: Department of Vitreoretinal Surgery, Rotterdam Eye Hospital, Rotterdam, The Netherlands. kmaaijwee@hotmail.com
authors.forename: Kristel
authors.initials: K
authors.lastname: Maaijwee
authors.forename: Tom
authors.initials: T
authors.lastname: Missotten
authors.forename: Paul
authors.initials: P
authors.lastname: Mulder
authors.forename: Jan C
authors.initials: JC
authors.lastname: van Meurs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002829:Choroid / Q000637:transplantation*; D005122:Exudates and Transudates; D005260:Female; 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; D011446:Prospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*