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Surgery for macular disease

Uppal, G.S.; (2011) Surgery for macular disease. Doctoral thesis, UCL (University College London). Green open access

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Abstract

The MD will primarily examine the role of surgery in the management of the wet form of age related macular degeneration (AMD) and secondarily for specific inherited macular dystrophies. It is postulated that in the early stages of wet AMD and other sub-foveal disorders involving choroidal neovascular membranes (CNV), photoreceptor loss is relatively limited with the disease confined to the sub-foveal layers, namely the choriocapilliaris-Bruch membrane-retinal pigment epithelium (RPE) interface. At this stage the retina is affected functionally and reversibly but with time the damage becomes permanent and irreversible. As such a critical window of opportunity exists to: 1. Salvage function from the existing photoreceptor pool before fibrovascular proliferation causes marked ‘irreversible’ photoreceptor loss 2. Treat any visual loss that may be due to secondary and potentially ‘reversible’ factors such as sub-foveal fluid and haemorrhage and 3. Mechanically restore normal anatomy. Previous attempts at sub-macular surgery have been associated with the loss of RPE in the area of the CNV during removal that secondarily causes degeneration of photoreceptors. Consequently, different innovative surgical approaches, including 360-degree macular translocation and full thickness autologous RPE transplantation, are under investigation for the management of sub-foveal CNV. The rationale of surgery in both techniques is to effectively restore the choriocapilliaris-Bruch’s-RPE interface beneath the foveal photoreceptors and rescue function before fibrovascular proliferation causes marked ‘irreversible’ photoreceptor loss. Pilot studies have been established to: 1. Examine the surgical feasibility and the anatomical and functional outcomes for each procedure 2. Investigate the pathophysiology of the underlying disease processes. In addition, a number of parameters will be investigated to evaluate the quality of recovery of vision. This will include assessing fixation stability, reading ability, histopathological studies and electrophysiological correlates.

Type:Thesis (Doctoral)
Title:Surgery for macular disease
Open access status:An open access version is available from UCL Discovery
Language:English
UCL classification:UCL > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology

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