American Journal of Ophthalmology
Volume 142, Issue 1 , Pages 17-30.e8, July 2006

Autologous Translocation of the Choroid and Retinal Pigment Epithelium in Age-related Macular Degeneration

  • Antonia M. Joussen, MD

      Affiliations

    • Department of Vitreoretinal Surgery, Center for Ophthalmology, University of Cologne, Cologne
    • Corresponding Author InformationInquiries to Antonia M. Joussen, MD, University of Cologne, Department of Vitreoretinal Surgery, Joseph Stelzmannstrasse 9, Cologne 50931, Germany
    • ,
  • Florian M.A. Heussen, BS

      Affiliations

    • Department of Vitreoretinal Surgery, Center for Ophthalmology, University of Cologne, Cologne
    • ,
  • Sandra Joeres, MD

      Affiliations

    • Department of Vitreoretinal Surgery, Center for Ophthalmology, University of Cologne, Cologne
    • ,
  • Helene Llacer, MD

      Affiliations

    • Department of Vitreoretinal Surgery, Center for Ophthalmology, University of Cologne, Cologne
    • ,
  • Beate Prinz, OD

      Affiliations

    • Department of Vitreoretinal Surgery, Center for Ophthalmology, University of Cologne, Cologne
    • ,
  • Klaus Rohrschneider, MD

      Affiliations

    • Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
    • ,
  • Kristel J.M. Maaijwee, MD

      Affiliations

    • Rotterdam Eye Hospital, Rotterdam, The Netherlands
    • ,
  • Jan van Meurs, MD

      Affiliations

    • Rotterdam Eye Hospital, Rotterdam, The Netherlands
    • ,
  • Bernd Kirchhof, MD

      Affiliations

    • Department of Vitreoretinal Surgery, Center for Ophthalmology, University of Cologne, Cologne

Accepted 31 January 2006. published online 10 May 2006.

Purpose

To evaluate the autologous translocation of peripheral choroid and retinal pigment epithelium (RPE) in 45 eyes of 43 patients with age-related macular degeneration (AMD).

Design

Prospective nonrandomized study.

Methods

All patients had visual loss due to AMD (n = 5 classic membranes, n = 14 occult, n = 2 mixed, n = 16 pigment epithelial detachment (PED), n = 5 subretinal hemorrhage, n = 3 geographic atrophy). After extraction of the neovascular complex, an autologous peripheral full-thickness explant of RPE, Bruch membrane, and choroid was translocated from the midperiphery to the macula.

Results

Preoperative distant visual acuity ranged from 20/800 to 20/40. Reading vision ranged from 1.4 logarithm of reading acuity determination (logRAD) to 0.5 logRAD (0.04 to 0.32 Snellen equivalent). Revision surgery was required in 22 eyes as a result of proliferative vitreoretinopathy (PVR), retinal detachment, macular pucker, or vitreous hemorrhage. In eight patients, the patch was renewed. At six months, distant visual acuity ranged from light perception to 20/50 (increase of 15 letters in four eyes). Reading vision ranged from 1.4 to 0.4 logRAD. Visual outcome was unrelated to the type of AMD. Vascularization of the transplant was visible on indocyanine green (ICG) angiography in 40 of 42 eyes. In most patients, autofluorescence of the pigment epithelium was coincident with revascularization of the graft. Fixation on the patch was positively related to visual acuity.

Conclusions

Autologous translocation of a full-thickness transplant of choroid and RPE usually results in a vascularized and functioning graft. Vascularization was even achieved in patients with geographic atrophy. Fixation stability and microperimetry before the patch translocation may be helpful in selecting patients who will profit from surgery.

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 Supported in part by the Deutsche Forschungsgemeinschaft (DFG) Jo 324/6-1 und 6-2 (Emmy Noether), Jo 324/4-1, and Ki 743/5-1, and Ki 743/2-1. The Brunnenbusch Stein Stiftung and the Glaser Stiftung sponsored patient related costs and the RetinoVit Stiftung Köln was helpful in funding necessary equipment.Supplemental Material and Video available at AJO.com.

PII: S0002-9394(06)00302-3

doi:10.1016/j.ajo.2006.01.090

American Journal of Ophthalmology
Volume 142, Issue 1 , Pages 17-30.e8, July 2006

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