Abstract

FR.13.04

Retinal pigment epithelium and choroid translocation for exudative AMD with or without 180° retinotomy

Szurman P., Yörük E., Aisenbrey S., Jaissle G., Spitzer M., Lüke M., Bartz-Schmidt K. U.
Universitäts-Augenklinik Tübingen, Augenheilkunde I, Tübingen

Objective: To evaluate and compare the translocation of autologous peripheral choroid and retinal pigment epithelium with or without 180° retinotomy.
Methods: Between June 2004 and Februar 2007 24 patients with exudative AMD and subretinal hemorrhage underwent CNV removal and choroid patch translocation from the midperiphery. In 8 patients the CNV was extracted and a full-thickness explant of RPE, Bruch membrane and choroid patch implanted under the fovea via a small paracentral retinotomy (group 1). In 16 patients a 180° temporal retinotomy was performed, the neovascular complex removed, a choroid patch from the lower periphery excised without the retinal layer, and the patch translocated under the fovea (group 2).
Results: The mean age of patients was 75,0±9,2 and 77,6±6,9 years, and the mean follow-up was 19,7±8,8 and 5,2±4,0 months, respectively. In group 1, visual acuity remained stable at 0.04 (LogMAR 1,4±0,34 preoperatively, 1,4±0,2 postoperatively). In group 2, visual acuity improved from couting fingers to 0.032 (LogMAR 1,76±0,5 preoperatively, 1,5±0,4, postoperatively, p=0,172). A different rate of severe complications was observed between group 1 and 2, e.g. PVR (62.5% vs. 6.3%) and significant bleeding in the patch area (37.5% vs. 18.8%). Significant improvement of 3 or more lines was only seen in group 2 (62.5% vs. 0%).
Conclusions: Patch translocation via 180° retinotomy seems to provide a more controlled operative procedure with significantly less complications and better visual improvement than previously described translocation techniques via a small paracentral retinotomy. However, visual improvement has been limited by the anatomic conditions given preoperatively. After exhausting the medical options a full-thickness patch translocation via a 180° retinotomy might be a treatment alternative for exudative AMD.

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