Rapid Recurrence of Geographic Atrophy after Full Macular Translocation for Nonexudative Age-Related Macular Degeneration

doi:10.1016/j.ophtha.2005.04.016

Ophthalmology

Volume 112, Issue 9, September 2005, Pages 1586-1591

https://doi.org/10.1016/j.ophtha.2005.04.016 Get rights and content

Objective

To report the recurrence of geographic atrophy (GA) in a patient with nonexudative age-related macular degeneration (AMD) after full macular translocation.

Design

Observational case report.

Methods

Review of the clinical, photographic, and angiographic records of a patient with GA who underwent full macular translocation.

Main Outcome Measures

Progression of GA.

Results

A 73-year-old man with GA secondary to nonexudative AMD underwent a macular translocation with 360 peripheral retinectomy (MT 360) in his left eye. On postoperative month 4, fundus photography showed subtle alterations of the pigment underneath the translocated foveal region. On postoperative month 9, the visual acuity worsened to preoperative levels and there was frank retinal pigment epithelium atrophy involving the new macular region.

Conclusions

The rapid recurrence and development of GA in the translocated fovea after MT 360 raise new questions regarding the pathogenesis of GA. They also raise concerns regarding the use of MT 360 in the management of nonexudative AMD.

Section snippets

Case Report

A 73-year-old man had a recent history of decreased vision in the left eye. His ophthalmic history was significant for nonexudative AMD in both eyes (diagnosed 5 years previously). The patient’s best-corrected visual acuity was counting fingers in the right eye and 20/400 in the left eye. He had mild nuclear sclerotic cataracts bilaterally and a central area of GA in the macular region in both eyes, within which there was a small central island of relatively normal-appearing RPE in the left eye

Discussion

Atrophic macular disease generally is characterized by RPE atrophy, often with associated loss of the choriocapillaris and photoreceptors. Geographic atrophy, the advanced atrophic form of AMD, typically progresses gradually over time, often sparing the fovea until late in the course of the disease.⁵ It is believed by some investigators that the primary loss of RPE leads to the secondary loss of photoreceptors and the development of central scotomas. It has been shown, however, that there is

References (9)

G.Y. Fujii et al.
Patient selection for macular translocation surgery using the scanning laser ophthalmoscope
Ophthalmology
(2002)
J.S. Sunness et al.
Visual function abnormalities and prognosis in eyes with age-related geographic atrophy of the macula and good visual acuity
Ophthalmology
(1997)
H. Schatz et al.
Atrophic macular degeneration. Rate of spread of geographic atrophy and visual loss
Ophthalmology
(1989)
J.S. Sunness
The natural history of geographic atrophy, the advanced atrophic form of age-related macular degeneration
Mol Vis
(1999)

There are more references available in the full text version of this article.

Cited by (29)

Targeting complement components C3 and C5 for the retina: Key concepts and lingering questions
2021, Progress in Retinal and Eye Research
Citation Excerpt :
However, using a histopathological assessment, Bird et al. have demonstrated GA cases where there is significant photoreceptor loss away from the GA lesion edge (Bird et al., 2014). We must also remember that some surgical cases of macular translocation led to subsequent RPE atrophy at the location where photoreceptor-deficient retina was translocated (Khurana et al., 2005). There may be GA subtypes that are driven first by photoreceptor defects and other subtypes driven first by RPE or choriocapillaris loss.
Age-related macular degeneration (AMD) remains a major cause of legal blindness, and treatment for the geographic atrophy form of AMD is a significant unmet need. Dysregulation of the complement cascade is thought to be instrumental for AMD pathophysiology. In particular, C3 and C5 are pivotal components of the complement cascade and have become leading therapeutic targets for AMD. In this article, we discuss C3 and C5 in detail, including their roles in AMD, biochemical and structural aspects, locations of expression, and the functions of C3 and C5 fragments. Further, the article critically reviews developing therapeutics aimed at C3 and C5, underscoring the potential effects of broad inhibition of complement at the level of C3 versus more specific inhibition at C5. The relationships of complement biology to the inflammasome and microglia/macrophage activity are highlighted. Concepts of C3 and C5 biology will be emphasized, while we point out questions that need to be settled and directions for future investigations.
Major challenges in vitreoretinal surgery
2015, Taiwan Journal of Ophthalmology
Citation Excerpt :
However, one patient had rapid RPE atrophy development and GA progression at the new fovea after surgery. This complication was further confirmed by other studies where rapid foveal RPE atrophy occurred in GA patients after FMT.55,56 Several studies have also reported the use of FMT or LMT to treat non-AMD, such as macular degeneration caused by high myopia.57,58
Since the first vitrectomy surgery was used for treatment of vitreoretinal diseases, surgical techniques and instrumentation have been rapidly improved in the past decades. However, there are complicated vitreoretinal diseases that cannot be successfully treated, even with state-of-the-art surgeries. The outcomes of some complicated cases are still poor due to different reasons and debates still remain in some areas regarding what are the best treatments. There is still a lack of full understanding on many complicated vitreoretinal diseases, such as the molecular basis of proliferative vitreoretinopathy (PVR), the role of scleral buckling (SB) in the management of rhegmatogenous retinal detachment (RRD), the optimal surgical consideration for pediatric RD, and the possibility of surgical management for various retinal degenerations and congenital retinal anomalies. This review discusses the current understandings of some complicated vitreoretinal diseases.
Macular translocation
2012, Retina Fifth Edition
Long-term Follow-up of Full Macular Translocation for Choroidal Neovascularization
2010, American Journal of Ophthalmology
Citation Excerpt :
Therefore, the new fovea sometimes became atrophic if the original fovea was moved over the seemingly normal RPE. There was an interesting report that RPE geographic atrophy had spread rapidly after full macular translocation for atrophic AMD.14 RPE cell implantation was attempted for RPE atrophy, but it did not achieve good results.15
To report the long-term (>5 years) results of full macular translocation in patients with choroidal neovascularization (CNV).
Retrospective, interventional case series.
This study involved 32 eyes of 32 patients who had undergone full macular translocation for CNV. The median follow-up was 6.5 years (range, 5.2 to 7.7 years). We evaluated the best-corrected visual acuity, fundus examination results obtained before and 1 and 5 years after operation, and postoperative complications.
At the 1-year follow-up, foveal retinal pigment epithelium atrophy was observed in only 3 eyes (12%), and the mean logarithm of the minimal angle of resolution (logMAR) visual acuity (VA) at that time (1.39 ± 0.67) was not significantly changed from that before surgery (logMAR, 1.31 ± 0.66) in 25 eyes with age-related macular degeneration (AMD). However, at 5-year follow-up, foveal retinal pigment epithelium atrophy increased (18 eyes; 72%), and final mean logMAR VA (1.88 ± 0.76) was significantly lower (P < .01). Five eyes with myopic CNV maintained their VA from before operation (mean logMAR, 0.88 ± 0.35) until final follow-up (mean logMAR, 0.73 ± 0.31). The final VA was significantly better in myopic CNV than in exudative age-related macular degeneration on multiple regression analysis (P = .019).
Long-term follow-up of full macular translocation showed that the final VA was poor in age-related macular degeneration, but relatively better in myopic CNV.
RPE transplantation and its role in retinal disease
2007, Progress in Retinal and Eye Research
Retinal pigment epithelial (RPE) transplantation aims to restore the subretinal anatomy and re-establish the critical interaction between the RPE and the photoreceptor, which is fundamental to sight. The field has developed over the past 20 years with advances coming from a large body of animal work and more recently a considerable number of human trials. Enormous progress has been made with the potential for at least partial restoration of visual function in both animal and human clinical work. Diseases that have been treated with RPE transplantation demonstrating partial reversal of vision loss include primary RPE dystrophies such as the merTK dystrophy in the Royal College of Surgeons (RCS) rat and in humans, photoreceptor dystrophies as well as complex retinal diseases such as atrophic and neovascular age-related macular degeneration (AMD). Unfortunately, in the human trials the visual recovery has been limited at best and full visual recovery has not been demonstrated. Autologous full-thickness transplants have been used most commonly and effectively in human disease but the search for a cell source to replace autologous RPE such as embryonic stem cells, marrow-derived stem cells, umbilical cord-derived cells as well as immortalised cell lines continues. The combination of cell transplantation with other modalities of treatment such as gene transfer remains an exciting future prospect. RPE transplantation has already been shown to be capable of restoring the subretinal anatomy and improving photoreceptor function in a variety of retinal diseases. In the near future, refinements of current techniques are likely to allow RPE transplantation to enter the mainstream of retinal therapy at a time when the treatment of previously blinding retinal diseases is finally becoming a reality.
Autologous Translocation of the Choroid and Retinal Pigment Epithelium in Patients with Geographic Atrophy
2007, Ophthalmology
Citation Excerpt :
At postoperative month 4 after macular translocation in a patient with geographic atrophy, fundus photography showed subtle alterations of the pigment underneath the translocated foveal region. At postoperative month 9, VA worsened to preoperative levels, and there was frank RPE atrophy involving the new macular region.18,20 This extensive atrophy is in contrast to the pigment mottling that can be seen in some patients after macular translocation in wet AMD.
To evaluate the functional and anatomical outcomes of autologous translocation of peripheral choroid and retinal pigment epithelium (RPE) in patients with geographic atrophy.
Prospective nonrandomized study.
Twelve consecutive patients with geographic atrophy secondary to age-related macular degeneration presenting with recent loss of reading vision.
An autologous peripheral full-thickness graft of RPE, Bruch’s membrane, and choroid was positioned under the macula in patients with geographic atrophy.
Functional tests included Early Treatment Diabetic Retinopathy Study distant vision, reading (Radner Test, measured as logarithm of the reading acuity determination [logRAD]), threshold static perimetry, and determination of the point of fixation. Fluorescein and indocyanine green angiography, autofluorescence, and optical coherence tomography served to evaluate the anatomical outcome in a 6-month follow-up (12 months in 7 patients).
Preoperative visual acuity (VA) ranged from 20/800 to 20/40 (mean, 0.6±0.4 logarithm of the minimum angle of resolution), and reading vision from 1.1 to 0.5 logRAD (mean, 0.8±0.2). Three patients were unable to read. Six months after surgery, VA ranged from hand movements to 20/32, with an increase of ≥5 letters in 2 eyes. Two patients without reading ability preoperatively were able to read after surgery. Reading was possible in a total of 8 patients after 6 months (1.3–0.4 logRAD). In 7 patients who were observed for 1 year, VA remained stable (±1 line) in 5 eyes and decreased in 2 eyes between 6 months’ and 1 year’s follow-up. In all eyes but 2, revascularization was visible on indocyanine green angiography as early as 3 weeks after surgery. Autofluorescence of the RPE was independent of revascularization of the graft and persisted throughout follow-up. Four eyes had unstable fixation and/or extrafoveal fixation before surgery. Two of these eyes stabilized during follow-up. Areas overlying atrophic areas demonstrated low threshold sensitivities that persisted after translocation of a free graft with only limited recovery. Revisional surgery due to proliferative vitreoretinopathy was required in 5 eyes.
The translocation of a full-thickness graft usually results in a vascularized and functioning graft in patients with geographic atrophy, although is associated with a high risk of complications and visual loss. Longer follow-up is necessary to learn about the long-term survival and functionality of the graft.

View all citing articles on Scopus

Manuscript no. 2005-109.

Supported by Research to Prevent Blindness, Inc., New York, New York.

View full text

Original articleRapid Recurrence of Geographic Atrophy after Full Macular Translocation for Nonexudative Age-Related Macular Degeneration

Objective

Design

Methods

Main Outcome Measures

Results

Conclusions

Section snippets

Case Report

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

The natural history of geographic atrophy, the advanced atrophic form of age-related macular degeneration

Mol Vis

Original article
Rapid Recurrence of Geographic Atrophy after Full Macular Translocation for Nonexudative Age-Related Macular Degeneration