Long-term results after limited macular translocation surgery for wet age-related macular degeneration

Abstract

PurposeTo evaluate the long-term results of limited macular translocation (LMT) surgery with radial chorioscleral outfolding in patients with wet age-related macular degeneration (AMD) and subfoveal choroidal neovascularization (CNV). In addition, to identify the factors associated with the final best-corrected visual acuity (BCVA).MethodsThe medical records of 20 eyes of 20 consecutive patients (65.2±9.8 years) who had undergone LMT for the treatment of wet AMD and were followed for at least 5 years, were reviewed. The surgical outcomes including the BCVA, degree of foveal displacement, and complications were recorded.ResultsThe mean foveal displacement was 1332 ± 393 μm after the LMT. The CNV was removed in 16 eyes and photocoagulated in 4 eyes. The mean preoperative VA was 0.83 ± 0.33 logMAR units which significantly improved to 0.59 ± 0.37 logMAR units at 1 year after the surgery (P = 0.015). This BCVA was maintained at 0.59 ± 0.41 logMAR units on the final examination. The final BCVA was significantly correlated with that at 1 year after the surgery (r = 0.83, P<0.001). Multiple linear regression analysis showed that the final BCVA was significantly correlated with the BCVA at 1 year after the surgery (P<0.001), a recurrence of a CNV (P = 0.001), and the age (P = 0.022).ConclusionsLMT improves the BCVA significantly at 1 year, and the improved BCVA lasted for at least 5 years. These results indicate that the impaired function of the sensory retina at the fovea can recover on the new RPE after the displacement for at least 5 years. The ability to maintain good retinal function on the new RPE for a long period is important for future treatments of CNVs such as the transplantation of RPE cells and stem cells.

The influence of subretinal injection pressure on the microstructure of the monkey retina

“…Although we focused on injection pressure in the present study, several other factors should be considered with respect to the retinal damage caused by subretinal injection. The first is the volume of the liquid to be injected under the retina, which differs depending on the aim and content of the subretinal injection (tPA [2,4,26], adenovirus vector [5,6,8], cell suspension [27–29], or BSS [9–13]). It has been reported that excessive stretching of the retina by the injected liquid can cause photoreceptor cell death by extension stress [15].…”

“…Surgical subretinal injections are used to displace subretinal hemorrhages [1–4], deliver gene therapy for retinal degeneration [5–8], perform macular translocation in patients with age-related macular degeneration [9,10], remove hard foveal exudates [11], and resolve diffuse diabetic macular edema during planned foveal detachment procedures [12,13]. To ensure that visual function is preserved after such procedures, clinicians must not damage the macula, and a safe and reliable technique for subretinal injection must therefore be developed.…”

Development of Stem Cell Therapies for Retinal Degeneration

“…More conclusive proofof-concept studies for RPE cell replacement have come from autologous RPE transplants and macular translocation surgeries in AMD patients. These experimental surgeries involve either harvesting a patch of autologous RPE from the periphery of the patient's eye and transplanting it under the macular or repositioning the macular over healthy RPE cells (MacLaren et al 2007;Treumer et al 2007;van Romunde et al 2015;Oshima et al 2017). Improvements in visual acuity were observed and maintained in some patients.…”

Possibilities for Using Pluripotent Stem Cells for Restoring Damaged Eye Retinal Pigment Epithelium

“…There are various strategies for using autologous and allogeneic material for transplantation in patients with AMD [6] and other diseases associated with degenerative processes in the retina. Three main strategies are used for clinical trials with autologous material: translocation of the macula (e.g., [17]), autotransplantation of the RPE-choroid flap (e.g., [18]), and subretinal injection of a suspension of autologous RPE cells (e.g., [19]).…”