A comparison of macular translocation with patch graft in neovascular age-related macular degeneration.
OBJECTIVE
To compare the long-term outcomes of macular translocation (MT) and autologous RPE-choroid patch graft (PG) in patients with neovascular age-related macular degeneration (AMD).


METHODS
This is a retrospective review of the first 12 patients who underwent MT and the first 12 patients who underwent PG. Visual acuity (VA), contrast sensitivity (CS), clinical findings, and complications were recorded. Microperimetry and fundus imaging were reviewed. Outcome measures were the change in VA and CS over 3 years in each group and rates of complication. Microperimetry and fixation in three best cases from each group were described.


RESULTS
The two groups were matched for age and VA. Median follow-up durations were 41 (MT) and 38 (PG) months. Median VA (logMAR) was maintained in the MT group: 0.90 at baseline and 0.69 at 3 years (P=0.09) whereas in the PG group, median VA declined from 0.87 to 1.38 at 3 years (P<0.001). Both surgical modalities had high rates of detachment and macular edema. Although more extensive RPE damage occurred in PG, the graft resisted growth of recurrent choroidal neovascularization toward the fovea. Near normal VA was achievable by each technique but macular sensitivity and fixation stability were superior in the MT group.


CONCLUSIONS
In the present cohort, MT maintained VA for 3 years but PG did not. This outcome may be related to the differences in surgical approach, source of RPE, and choroidal perfusion. The authors recommend MT in preference to PG for treatment of patients with the second eye affected by neovascular AMD unsuitable for other treatment.
Chen
Fred K
FK
Moorfields Eye Hospital, London, United Kingdom. fkchen02@yahoo.com
Patel
Praveen J
PJ
Uppal
Gurmit S
GS
Rubin
Gary S
GS
Coffey
Peter J
PJ
Aylward
G William
GW
Da Cruz
Lyndon
L
D000368:Aged; D002829:Choroid / Q000637:transplantation*; D020256:Choroidal Neovascularization / Q000503:physiopathology / Q000601:surgery*; D015350:Contrast Sensitivity / Q000502:physiology; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D008266:Macula Lutea / Q000637:transplantation*; D008268:Macular Degeneration / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D055213:Retinal Pigment Epithelium / Q000637:transplantation*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology