http://repub.eur.nl/res/aut/14650/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/37214/ 2012-01-01T00:00:00Z To report and analyze long-term best-corrected visual acuity (BCVA) outcomes following a free autologous retinal pigment epithelium (RPE)-choroid graft translocation in patients with exudative age-related macular degeneration (AMD). Prospective cohort study. setting: Institutional. study population: One hundred and thirty consecutive patients (133 eyes) with AMD underwent RPE-choroid graft translocation between October 2001 and February 2006. All patients had a subfoveal choroidal neovascular membrane with or without hemorrhage and/or an RPE tear. All were either ineligible for or nonresponsive to photodynamic therapy, the standard treatment at the time of surgery. observation procedures: Data collection included preoperative and postoperative visual acuity measurements, fundus photography, fluorescein and indocyanine green angiography, and microperimetry. main outcome measures: Postoperative BCVA. The mean preoperative BCVA was 20/250. Four years after surgery, 15% of the eyes had a BCVA of >20/200, and 5% had a BCVA of <20/40. One patient achieved a BCVA of 20/32, which was maintained at 7 years after surgery. Complications consisted of proliferative vitreoretinopathy (n = 13), recurrent neovascularization (n = 13), and hypotony (n = 2). RPE-choroid graft transplantation may maintain macular function for up to 7 years after surgery, with relatively low complication and recurrence rates. Retinal sensitivity, BCVA data, and fixation on the graft suggest that the graft, rather than simply the removal of submacular hemorrhage and/or choroidal neovascular membrane, was responsible for the preservation of macular function. This surgery may be an alternative for patients with AMD who cannot undergo other standard treatment. http://repub.eur.nl/res/pub/16425/ 2009-04-01T00:00:00Z Purpose One-fourth of the patients with exudative age-related macular degeneration (AMD) treated with an autologous retinal pigment epithelium (RPE)-choroid translocation had a hyperfluorescent optic disc with indocyanine green angiography (ICGA). This study aimed to identify whether indocyanine green (ICG)-assisted surgery was related to the hyperfluorescence of the optic disc with ICGA.MethodsRetrospective observational case series of 31 AMD patients treated with an RPE-choroid translocation and who had ICGA after surgery. The ICGAs were assessed for hypo/iso/hyperfluorescence of the optic disc and fluorescence was related to the time interval between ICGA and the possible use of intravitreal ICG.ResultsThe optic disc was hyperfluorescent in six patients, isofluorescent in one, and hypofluorescent in 24 patients. All hyperfluorescent optic discs and 7 of the 24 hypofluorescent optic discs were preceded with ICG-assisted surgery with a time interval of 7±3 weeks and 43±12 weeks, respectively (P=0.001, Student t-test). The other 17 hypofluorescent discs were not preceded by ICG-assisted surgery and the one isofluorescent optic disc was observed 32 weeks after ICG-assisted surgery.ConclusionThere was a statistically significant correlation between intravitreal ICG use during surgery and a hyperfluorescent optic disc with ICGA in our patient group. http://repub.eur.nl/res/pub/30091/ 2008-05-01T00:00:00Z PURPOSE. To statistically analyze the test-retest and inter-chart reliability of the newly developed actual logarithmically scaled Dutch Radner Reading Charts in an older population affected by macular disease. These Dutch Radner Reading Charts are developed according to the strict principles of sentence construction of the originally German language Radner Reading Charts. METHODS. Thirty-six subjects aged 50 years or older and affected with a macular disease monocularly read the three charts of the Radner Reading Charts in a randomized order twice with 1 month in between. The subjects were divided into three groups according to their distance logMAR visual acuity (group 1, ≥0.1; group 2, 0.12 to 0.4; and group 3, 0.42 to 0.8). Reading acuity (logRAD, the reading equivalent of logMAR), logRAD score, maximum reading speed, critical print size, and logRAD/logMAR ratio were measured. Variance component analysis was used to determine the sources of variability. RESULTS. The test-retest and inter-chart reliability was high for all visual acuity groups and variables. For all groups together the chart accounted for maximal 5% of the total variability for all measurements. The individual subject did have the largest influence on the measurements (88 to 98% of the variability). CONCLUSIONS. The Dutch version of the Radner Reading Charts provided high reliable test-retest and inter-chart measurements of reading performance in a heterogeneous group of subjects with subnormal to low vision. This study also showed that the strict principles of sentence construction of the originally German Radner Reading Charts may also be successfully used for other languages. http://repub.eur.nl/res/pub/12279/ 2008-04-18T00:00:00Z Age-related macular degeneration (AMD) is the most important cause of irreversible legal blindness in elderly persons in industrialized countries. AMD has two forms: atrophic (dry) and exudative (wet). In the wet form, abnormal blood vessels, arising from the choriocapillaris (choroidal neovascularization, CNV) underneath the macula, grow through ruptures in the Bruch’s membrane, into the sub-retinal pigment epithelium (RPE) space or into the subretinal space, or a combination of both. Blood and serum leakage from the CNV below the RPE and/or below and within the retina are harmful and fi nally causes irreversible damage to the photoreceptors of the overlying macula which results in a central scotoma. http://repub.eur.nl/res/pub/29283/ 2008-04-01T00:00:00Z Purpose. During retinal pigment epithelium (RPE) and choroid graft translocation in the treatment of patients with exudative age-related macular degeneration, the adhesion of the graft to the translocation instrument complicated its submacular release. Vibration of the instrument improved the release of the graft. This study was conducted to validate the effectiveness of the principle of vibration and to determine the threshold amplitude and frequency required for development of an optimized instrument. Methods. An experimental in vitro model with fresh porcine RPE-choroid grafts was used. Release of the graft was studied by a masked observer for amplitudes in the range of 0.05 to 1.2 mm and frequencies in the range of 25 to 200 Hz in the horizontal plane. Results. The minimum threshold amplitude required to release the graft was approximately 0.15 mm from a frequency of 100 Hz and higher. Conclusions. This study confirmed the clinical experience that vibration of an instrument induces the release of the RPE- choroid graft. The minimum threshold amplitude and frequency needed for optimum tissue release were estimated. Copyright http://repub.eur.nl/res/pub/29299/ 2008-02-01T00:00:00Z Purpose. In a previous study, preoperative variables were correlated with postoperative visual outcome after the translocation of a free RPE- choroid graft. The present study was conducted to investigate whether the intraoperative course was an independent factor influencing visual outcome in these patients. Methods. This was a prospective interventional case series of 48 patients with exudative AMD treated with an RPE- choroid translocation. Preoperative and postoperative evaluation included ETDRS visual acuity (VA) and fixation testing by a masked examiner. Four critical surgical steps were evaluated, and the intraoperative course was graded from 0 (uncomplicated surgery) to 5 (most complicated surgery). The relationship between intraoperative course adjusted for preoperative delay/lesion composition and visual outcome at 3 months and 1 year after surgery was analyzed with multivariate analysis. Results. The mean VA (logMAR) improved slightly from 0.99 before surgery to 1.00, 0.94, 0.89, and 0.91 after 3, 6, 9, and 12 months, respectively. Foveal fixation on the graft was present in 34 (71%) of the eyes at 1 year after surgery. The intraoperative course was statistically significantly associated with the ΔVA (logMAR) at 3 months (P = 0.037) and at 1 year after surgery (P = 0.020) and if measured as gain or loss of ≥2 ETDRS-lines (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.7 to 2.8, P = 0.027) and ≥3 ETDRS lines (OR, 2.2, 95% CI 1.9-3.5, P = 0.003); better surgery was associated with visual gain whereas eventful surgery was associated with visual loss. Conclusions. The intraoperative course adjusted for preoperative variables had a statistically significant influence on postoperative visual outcomes in patients treated with a free RPE-choroid translocation. Refining the surgery could improve results. Copyright http://repub.eur.nl/res/pub/36168/ 2007-11-01T00:00:00Z Background: To study the results of the translocation of a free autologous retinal pigment epithelium (RPE)-choroid graft after removal of a subfoveal choroidal neovascular membrane in patients with exudative age-related macular degeneration (AMD), and to determine whether preoperative variables may predict visual outcome at 1 year after surgery. Methods: Prospective interventional case series of 84 eyes of 83 consecutive eligible patients with exudative AMD with a minimal follow-up of 1 year after surgery. Of this group, 45, 24 and 11 patients reached a follow-up of respectively 2, 3 and 4 years. Pre- and postoperative evaluation included ETDRS visual acuity (VA), fixation testing and color fundus photography. Preoperative fluorescein angiograms were assessed by masked readers for lesion size, size of hemorrhage and lesion composition according to the MPS criteria. The relationship between lesion composition adjusted for preoperative delay and VA, lesion size, percentage of blood, and visual outcome at 1 year after surgery was analyzed. Results: The mean VA (logMAR) improved slightly at 1 and 2 years (0.89, Δ = -0.06), 3 years (0.79, Δ = -0.16) and 4 years (0.74, Δ = -0.21) after surgery. Five patients had a preoperative VA better than 20/80, compared to 19 out of 84, six out of 45, four out of 24 and two out of 11 after 1, 2, 3 and 4 years respectively. Fixation was located on the graft in 62 patients (74%) up to the last examination. Predominantly classic and occult lesions had a significant better prognosis than minimally classic or hemorrhagic (<50% blood) lesions. Retinal detachment occurred in seven patients; two caused by rhegmatogenous detachment and five caused by proliferative vitreoretinopathy. In 11 eyes, a recurrent or persisting neovascular membrane was observed. Conclusion: An autologous free RPE-choroid graft may stabilize or improve vision in patients with exudative AMD up to 4 years after surgery. http://repub.eur.nl/res/pub/35488/ 2007-04-01T00:00:00Z Background: Translocation of a free autologous graft consisting of retinal pigment epithelium (RPE), Bruch's membrane, choriocapillaris and choroid in patients with exudative age-related macular degeneration is currently being evaluated in clinical practice. Angiographic studies in these patients suggest that their grafts become revascularised. Aim: To investigate the histological evidence of revascularisation of the graft in a porcine model. Methods: In 11 pigs (11 eyes), an RPE-choroid graft was translocated from the mid-periphery to an intact or an intentionally damaged RPE and Bruch's membrane at the recipient site. The eyes were enucleated 1 week or 3 months after surgery. Tissue sections were evaluated using immunohistochemistry. Results: Bridging vessels between recipient layer and graft were identified from 1 week to 3 months after surgery. This reconnection occurred regardless of whether the Bruch's membrane of the recipient site was left intact or intentionally damaged at the time of transplantation. The vasculature of the graft appeared open and perfused. Vessels with transcapillary pillars and conglomerates of small new vessels were present in the graft. Conclusions: This study showed histological evidence for revascularisation by angiogenesis of a free autologous RPE-choroid graft.