gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

Excimer-laser-assisted RPE sheet translocation (EST) following surgical excision of subfoveal choroidal neovascularization in AMD

Meeting Abstract

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  • corresponding author A. Bindewald - Department of Ophthalmology, University of Bonn, Bonn
  • H. Specht - Department of Ophthalmology, University of Heidelberg, Heidelberg
  • F. Roth - Department of Ophthalmology, University of Bonn, Bonn
  • F.G. Holz - Department of Ophthalmology, University of Bonn, Bonn

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogP 164

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Veröffentlicht: 22. September 2004

© 2004 Bindewald et al.
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Surgical excision of subfoveal choroidal neovascularizations (CNV) is usually associated with inadvertent removal of the corresponding retinal pigment epithelium (RPE) and subsequent functional loss. We developed and evaluated a novel technique for intraocular excimer laser microablation of choroidal tissue from peripherally excised RPE/Bruch's membrane/choroid patches to obtain autologous RPE sheets for translocation under the macular neurosensory retina following removal of subfoveal CNV.


(I) Using a 308 nm excimer laser choroidal tissue was ablated from excised grafts in human donor eyes. Custom made Laser probes of 600μm in diameter were used that can be introduced via routine sclerotomies. Specimen were evaluated morphologically with light and electron microscopy. (II) In 3 patients with subfoveal occult CNV due to AMD such a graft was obtained from the midperiphery, treated with 308nm excimer laser and translocated under the macula with a special suction spatula via a small retinotomy temporal to the fovea following surgical CNV excision. Pre- and postoperative evaluations included fundus autofluorescence imaging, fluorescence angiography and SLO fundus perimetry.


(I) Choroidal tissue was efficiently ablated with the 308nm excimer laser ex vivo. An increase of the distance of the tip to the tissue led to larger ablation areas. Best effects were noted with the tip close to the tissue. Larger choroidal vessels were more resistant than the connective tissue. There were no visible morphological alterations of the RPE cell monolayer. (II) Retinal sensitivity and improvement in central fixation in the corresponding area after excimer laser assisted RPE sheet translocation (EST) was demonstrated by fundus perimetry. A viable RPE cell layer was confirmed by fundus autofluorescence imaging.


Choroidal tissue from midperipheral full-thickness RPE/Bruch's membrane/choroid grafts can be efficiently ablated with a 308nm excimer laser. Less resistance for diffusion of metabolites would be expected compared to full-thickness grafts and, thus, better postoperative RPE and inner neurosensory retinal function. The laser probes allow for entry via regular pars plana sclerotomies and intraocular ablation. Preliminary clinical results indicate that EST results in functional grafts and that it has the potential to improve the visual outlook in patients with neovascular AMD. Further clinical studies are needed to assess safety and efficacy of this procedure.