Translocation of autologous retinal pigment epithelium and choroid in patients with exudative age–related macular degeneration: further follow–up.

Abstract

Abstract: : Purpose: To evaluate the function and survival of a midperipheral autologous retinal pigment epithelium (RPE) and choroid transplant under the macula of patients with age–related exudative macular degeneration. Methods: Prospective evaluation of 18 patients with a follow–up of 1 to 2 years. All patients had a subfoveal choroidal neovascularization of greater than 1 disk diameter, in 10 with a submacular hemorrhage. Preoperative vision ranged from 20/400 to 20/160. After extraction of the subfoveal neovascular membrane, a full–thickness patch of RPE and choroid was cut out from the midperiphery and repositioned under the macula. Functional tests included ETDRS vision, fixation on the OCT screen, OCT, fluorescein and indocyanide green angiography, scanning laser autofluorescence and fundus perimetry. Results: 9 patients had a vision of 20/125 or better, with 2 20/50. Preferred fixation was on the patch in 13. In 14 patients the retina was thinner over the patch than over the atrophic area around, on OCT. Revascularization of the patch on angiography was present in 8 so examined patients. Autofluorescence of the patch persisted in 9 of 10 examined patients. Fundusperimetry showed function over the patch in 12 of 14 examined patients. Recurrent neoscularzation was observed in 3 patients. Conclusions: The translocation of an autologous patch of RPE and choroid may result in a surviving graft under the macula that may support macular function for over two years. Longer follow–up and refinement of the surgery remains necessary.

Keywords: age–related macular degeneration • transplantation • retinal pigment epithelium