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(Investigative Ophthalmology and Visual Science. 2008;49:758-761.)
© 2008 by The Association for Research in Vision and Ophthalmology, Inc.
DOI:  10.1167/iovs.07-0510
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Influence of Intraoperative Course on Visual Outcome after an RPE–Choroid Translocation

Kristel Maaijwee,1 Tom Missotten,2 Paul Mulder,3 and Jan C. van Meurs1,4

1From the Departments of Vitreoretinal Surgery and 2Medical Retina, the Rotterdam Eye Hospital, Rotterdam, The Netherlands; the 3Department of Epidemiology & Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands; and the 4Erasmus University Rotterdam, Rotterdam, The Netherlands.

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 {Delta}VA (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.




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