Retinal pigment epithelium translocation after choroidal neovascular membrane removal in age-related macular degeneration3☆,
Section snippets
Patients and methods
Nine previously untreated patients diagnosed with subfoveal CNV secondary to ARMD participated in the study. All but two patients had visual loss of 20/200 or worse for at least 3 to 9 months duration in their study eye (Table 1). The remaining two patients had a preoperative vision of 20/100 with a 2-month history of visual loss. Choroidal neovascularization was confirmed by fluorescein angiography, and in each case the complex was larger that one disc area. All patients previously had lost
Results
In all but two of the nine patients, it proved possible to translocate a full-thickness graft of RPE and choroid to a subfoveal location, where it remained. In patient 1, we attempted to maintain a pedicle, but it was not possible to achieve sufficient translocation to position it under the fovea. In patient 4, review of the surgical video suggested that the graft had become inverted during translocation. Subretinal hemorrhage was not a significant problem. Intraoperative bleeding was
Discussion
In 1991, Thomas and Kaplan6 published the first report on the surgical excision of subfoveal neovascular membranes. It became evident that in ARMD, this was associated with loss of the central RPE and choriocapillaris with a poor visual outcome.9, 29 The observations of Gass,30 in which he defined type 1 and type 2 lesions, showed that this is inevitable. He addressed the need to find the means for resurfacing the bed of the surgically excised CNV with RPE. Animal studies show that transplanted
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Supported by the Lady Anne Allerton Fund, London, England.
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The authors have no proprietary or financial interest related to this manuscript.