Joussen Antonia M, Joeres Sandra, Fawzy Nader, Heussen Florian M A, Llacer Helene, van Meurs Jan C, Kirchhof Bernd
Department of Ophthalmology, University of Duesseldorf, Duesseldorf, Germany.
Ophthalmology. 2007 Mar;114(3):551-60. doi: 10.1016/j.ophtha.2006.08.016.
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 > or =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.
评估地理性萎缩患者自体周边脉络膜和视网膜色素上皮（RPE）移植后的功能和解剖学转归。
前瞻性非随机研究。
12例年龄相关性黄斑变性继发地理性萎缩且近期阅读视力丧失的连续患者。
对地理性萎缩患者，将自体RPE、 Bruch膜和脉络膜的周边全层移植物置于黄斑下方。
功能测试包括糖尿病视网膜病变早期治疗研究远视力、阅读（拉德纳测试，以阅读视力测定对数[logRAD]衡量）、阈值静态视野检查以及注视点测定。荧光素和吲哚菁绿血管造影、自发荧光和光学相干断层扫描用于在6个月随访（7例患者为12个月）时评估解剖学转归。
术前视力（VA）范围为20/800至20/40（平均，最小分辨角对数为0.6±0.4），阅读视力为1.1至0.5 logRAD（平均，为0.8±0.2）。3例患者无法阅读。术后6个月，VA范围从手动视力至20/32，2只眼视力提高≥5行。2例术前无阅读能力的患者术后能够阅读。6个月后共有8例患者能够阅读（1.3 - 0.4 logRAD）。在7例随访1年的患者中，5只眼的VA在6个月至1年随访期间保持稳定（±1行），2只眼下降。除2只眼外所有眼在术后最早3周时吲哚菁绿血管造影可见血管再生。RPE的自发荧光与移植物血管再生无关且在整个随访期间持续存在。4只眼术前注视不稳定和/或注视点偏离黄斑中心凹。其中2只眼在随访期间稳定。覆盖萎缩区域的部位显示低阈值敏感度，在游离移植物移植后持续存在且恢复有限。5只眼因增殖性玻璃体视网膜病变需要进行翻修手术。
全层移植物移植通常会使地理性萎缩患者的移植物血管化并发挥功能，尽管其与并发症和视力丧失的高风险相关。需要更长时间的随访以了解移植物的长期存活和功能。
