Long-Term Results of Full Macular Translocation for Choroidal Neovascularization in Age-Related Macular Degeneration

Romunde, Saskia Helena Margaretha van; Polito, Antonio; Bertazzi, Laura; Guerriero, Massimo; Pertile, Grazia

doi:10.1016/j.ophtha.2015.03.012

Cited by 20 publications

(15 citation statements)

References 29 publications

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“…In a previous study, we demonstrated that FMT can improve the visual function in the majority of patients with exudative AMD that are unlikely to benefit from anti‐VEGF (van Romunde et al. ). This is not surprising, as the RPE‐choriocapillaris complex is known to play a key role in retinal metabolism, including nutrition and elimination of waste products.…”

Section: Discussionmentioning

confidence: 88%

Morphological changes in the diseased retina on a healthy choroid‐retinal pigment epithelial complex after full macular translocation for exudative age‐related macular degeneration

Romunde

Polito

Deiro

et al. 2018

Acta Ophthalmologica

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Purpose: To describe the change in the retinal morphology after full macular translocation (FMT) for exudative age-related macular degeneration (AMD) and identify predictive factors for the visual outcome. Methods: All patients who underwent FMT from December 2008 through July 2013 were selected. Exclusion criteria were FMT for other disease than AMD, age <60 years, <12 months of follow-up or no available images. Spectral domain optical coherence tomography, fundus autofluorescence, fluorangiography and indocyanine green angiography were evaluated. Results: In total, 51 patients were included with a mean follow-up of 30 months. The presence of the external limiting membrane (ELM) was a significant predictor for a favourable visual outcome 1 year after FMT (OR = À0.30). Other significant predictive factors were the absence of intraretinal fluid (OR = 0.28) and the mixed choroidal neovascularization type (OR = À0.47), whereas nonresponders (OR = 0.41) and fibrotic lesions (OR = 0.35) were less likely to have a good visual function after surgery. Conclusion: Full macular translocation (FMT), that permits to relocate the diseased macula onto an area of unaffected retinal pigment epithelial and choroid, can restore the anatomy and visual function in some patients with AMD when the outer retina layers are not irreversibly damaged. The presence of the ELM seems to be the most reliable factor in predicting the functional outcome.

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Section: Discussionmentioning

confidence: 88%

Morphological changes in the diseased retina on a healthy choroid‐retinal pigment epithelial complex after full macular translocation for exudative age‐related macular degeneration

Romunde

Polito

Deiro

et al. 2018

Acta Ophthalmologica

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“…Another possible approach to the management of SMH is submacular surgery as a first therapeutic option, without any prior gas displacement of blood. In fact, although the Submacular Surgery Trial [30] could not demonstrate any benefit from the simple removal of CNV and blood in eyes with predominantly haemorrhagic CNV secondary to AMD, diverse surgical approaches such as FMT and autologous RPE-choroid patch grafting, which are able to restore the RPE-choroid complex underneath the macula, have been found to preserve macular function and improve vision in selected cases [16,17,31,32]. However, it is most likely that the majority of patients affected by AMD with an acute SMH might benefit from early displacement by rtPA and gas injection followed by the continuation of anti-VEGF treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Surgery included full macular translocation (FMT) or autologous RPE-choroid patch grafting, performed as described elsewhere [14][15][16][17], in case of the presence or absence of end-stage disease in the fellow eye, respectively. In particular, FMT, including a 45-degree retinal rotation and compensatory muscle surgery, was performed only in patients with very low vision in the fellow eye so as to prevent the risk of diplopia.…”

Section: Evaluation Procedures and Treatmentsmentioning

confidence: 99%

Intravitreal Recombinant Tissue Plasminogen Activator and Sulphur Hexafluoride Gas for Submacular Haemorrhage Displacement in Age-Related Macular Degeneration: Looking behind the Blood

et al. 2020

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Purpose: To evaluate the effectiveness of recombinant tissue plasminogen activator (rtPA) and sulphur hexafluoride gas (SF 6 ) intravitreal injection for the displacement of large submacular haemorrhages (SMH) secondary to neovascular age-related macular degeneration and for guiding the selection of additional treatments or observations for choroidal neovascularization (CNV). Methods: The medical records of consecutive patients with recent-onset, large SMH, , were retrospectively analysed. All eyes underwent a 0.05-mL intravitreal injection of 50 μg rtPA, 0.3 mL of 100% SF 6 , and then face-down positioning. Afterwards, the eyes received additional treatments for CNV or observation, based on the severity and extent of the underlying pathology. The multimodal imaging features revealed after blood displacement were analysed and then correlated to the treatment selected as a second therapeutic option. Results: A total of 96 eyes met the inclusion criteria and was evaluated in this study. SMH was displaced from the fovea in the majority of the eyes (76%), allowing several diagnostic tools to evaluate the underlying macular features. In 19 cases (19.8%) exhibiting severe macular damage, no additional treatment was applied. In the remaining eyes, subsequent treatments included anti-vascular endothelial growth factor injections (44.8%), photodynamic therapy (n = 2), and submacular surgery (35.4%). Statistically significant correlations were found between the macular findings revealed after blood displacement and the additional treatments or observations selected for the underlying disease. The mean follow-up was 35 months. Improvements in visual acuity were statistically significant up to 3 years. Conclusion: Intravitreal rtPA and gas injection was found to be effective for the displacement of large SMH, allowing postoperative diagnostic testing, and thus guiding the opportunity to apply further treatments. The addition of subsequent individualized treatments may allow long-term visual gain in selected cases.

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“…However, the administration of anti-VEGF therapy has led to some severe side effects such as stroke [30]. Moreover, VEGF inhibitors have shown to be ineffective in a subset of AMD patients [33]. Hence, other options for treating this disease need to be explored.…”

Section: Introductionmentioning

confidence: 99%

miRNA involvement in angiogenesis in age-related macular degeneration

et al. 2016

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Age-related macular degeneration (AMD) is the leading cause of blindness in the elderly. Late-stage AMD is characterized by choroidal neovascularization (CNV). miR-93 appears to play a role in regulating vascular endothelial growth factor-A (VEGF-A), a known factor involved in neovascularization. Understanding its biological significance might enable development of therapeutic interventions for diseases like AMD. We aimed to determine the role of miR-93 in AMD using a laser-induced CNV mouse model. CNV was induced by laser photocoagulation in C57BL/6 mice. The CNV mice were transfected with scrambled miR or miR-93 mimic. The treatment effect was assessed by fundus photography and fluorescein angiography and confirmed by choroidal flatmount. The expression of miR-93 and VEGF-A in ocular tissues was analysed by quantitative polymerase chain reaction (qPCR) and Western blot. The overexpression effects of miR-93 were also proved on human microvascular endothelial cells (HMECs). Significantly decreased expression of miR-93 was observed by qPCR analysis in CNV mice compared to untreated mice (p < 0.05). VEGF-A messenger RNA (mRNA) and protein expression were upregulated with CNV; these changes were ameliorated by restoration of miR-93 (p < 0.05). CNV was reduced after miR-93 transfection. Transfection of miR-93 reduced the proliferation of HMECs (p < 0.01), but no significant changes were observed in 2D capillary-like tube formation (p > 0.05) and migration (p > 0.05) compared with that in the untreated cells. miR-93 has been shown to be a negative modulator of angiogenesis in the eye. All together, these results highlight the therapeutic potential of miR-93 and suggest that it may contribute as a putative therapeutic target for AMD in humans.

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Long-Term Results of Full Macular Translocation for Choroidal Neovascularization in Age-Related Macular Degeneration

Cited by 20 publications

References 29 publications

Morphological changes in the diseased retina on a healthy choroid‐retinal pigment epithelial complex after full macular translocation for exudative age‐related macular degeneration

Morphological changes in the diseased retina on a healthy choroid‐retinal pigment epithelial complex after full macular translocation for exudative age‐related macular degeneration

Intravitreal Recombinant Tissue Plasminogen Activator and Sulphur Hexafluoride Gas for Submacular Haemorrhage Displacement in Age-Related Macular Degeneration: Looking behind the Blood

miRNA involvement in angiogenesis in age-related macular degeneration

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