Long-term results of submacular surgery combined with macular translocation of the retinal pigment epithelium in neovascular age-related macular degeneration

Purpose: To provide long-term (>= 5 years) follow-up data on patients who had previously undergone macular retinal pigment epithelium (RPE) translocation surgery for choroidal new vessels (CNVs) associated with age-related macular degeneration. Design: Retrospective interventional case series. Participants: Four of 9 patients who originally underwent surgery and whose results were reported after 2 years of follow-up were reviewed again 5 to 6 years after surgery. Methods: All surviving patients from the original trial were contacted, and those who consented to full ocular examination were called in for review. Examination included best-corrected visual acuity (VA), optical coherence tomography (OCT), fundus autofluorescence, fluorescein angiography (FA), and indocyanine green angiography. Main Outcome Measures: Long-term success of RPE translocation was assessed by VA, imaging, angiography, and maintenance of overlying foveal fixation. Comparisons were made to the original 2-year follow-up data previously published. Results: Over the long term, VA had declined further in 3 patients and improved slightly in 1 patient. Significantly, all 4 patients had lost foveal fixation and autofluorescence of translocated RPE, which had been present at the original 2-year follow-up assessment. The RIPE graft, however, seemed viable when assessed by OCT, FA, and indocyanine green angiography, and no patient had suffered a recurrence of CNVs. Conclusions: In these 4 patients, RPE choroidal grafts had survived in the subfoveal space for at least 5 to 6 years, but rescue of visual function had been transient. The long-term loss of foveal fixation and graft autofluorescence might be explained by chronic photoreceptor apoptosis, initiated by either surgery or the disease process itself. Caution should be applied when drawing firm conclusions from similar studies that provide data after only 2 years' follow-up.