Elsevier

Ophthalmology

Volume 112, Issue 12, December 2005, Pages 2081-2087
Ophthalmology

Original Article
Long-term Results of Submacular Surgery Combined with Macular Translocation of the Retinal Pigment Epithelium in Neovascular Age-Related Macular Degeneration

Presented at: British and Eireland Association of Vitreoretinal Surgeons meeting, November, 2004; Manchester, United Kingdom.
https://doi.org/10.1016/j.ophtha.2005.06.029Get rights and content

Purpose

To provide long-term (≥5 years) follow-up data on patients who had previously undergone macular retinal pigment epithelium (RPE) translocation surgery for choroidal new vessels (CNVs) associated with age-related macular degeneration.

Design

Retrospective interventional case series.

Participants

Four of 9 patients who originally underwent surgery and whose results were reported after 2 years of follow-up were reviewed again 5 to 6 years after surgery.

Methods

All surviving patients from the original trial were contacted, and those who consented to full ocular examination were called in for review. Examination included best-corrected visual acuity (VA), optical coherence tomography (OCT), fundus autofluorescence, fluorescein angiography (FA), and indocyanine green angiography.

Main Outcome Measures

Long-term success of RPE translocation was assessed by VA, imaging, angiography, and maintenance of overlying foveal fixation. Comparisons were made to the original 2-year follow-up data previously published.

Results

Over the long term, VA had declined further in 3 patients and improved slightly in 1 patient. Significantly, all 4 patients had lost foveal fixation and autofluorescence of translocated RPE, which had been present at the original 2-year follow-up assessment. The RPE graft, however, seemed viable when assessed by OCT, FA, and indocyanine green angiography, and no patient had suffered a recurrence of CNVs.

Conclusions

In these 4 patients, RPE choroidal grafts had survived in the subfoveal space for at least 5 to 6 years, but rescue of visual function had been transient. The long-term loss of foveal fixation and graft autofluorescence might be explained by chronic photoreceptor apoptosis, initiated by either surgery or the disease process itself. Caution should be applied when drawing firm conclusions from similar studies that provide data after only 2 years’ follow-up.

Section snippets

Materials and Methods

Of the 9 original trial patients, 3 could not be contacted (one of whom had moved abroad), and 1 was known to be deceased. Two of the 6 contacted declined further investigation: one because she was terminally ill with cancer and the other because he was immobile as a result of a cerebrovascular accident. The 4 remaining patients agreed to return to the eye hospital for review and repeat investigations. These corresponded to male patients 2, 3, 4, and 6 from the original study and are

Results

All 4 patients offered positive comments about having been in the original trial, and none had suffered a recurrence of CNVs in either eye during the 5 to 6 years of follow-up. Two patients (3 and 6) felt their vision had improved as a result of surgery, patient 2 felt no change, and patient 4 felt his vision had declined further. Patient 4 also had underlying unilateral glaucoma, which had advanced significantly over the subsequent 5 years after surgery, and his left optic disc showed

Discussion

The 5- to 6-year follow-up of 4 of 9 AMD patients who originally underwent removal of CNVs with translocation of extrafoveal RPE across the macula revealed a further decline in VA and loss of foveal fixation. The decline occurred after the original description of the technique at the 2-year follow-up. Late changes in autofluorescence were also noted: increasing over the graft donor site and virtually disappearing over the graft itself.

Although the long-term results of this pilot study are

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Manuscript no. 2005-313.

Supported by the June Sutor Research Fellowship, London, United Kingdom; Frances Renée Hock Fund, London, United Kingdom; and Moorfields Trustees, London, United Kingdom.

The authors have no proprietary or financial interest related to the article or any technique described herein.

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