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Jan C van Meurs, Saskia HM van Romunde, Elsbeth T J van Zeeburg, Grazia Pertile; Inflammatory destruction of the RPE of an autologous RPE and choroid graft ?. Invest. Ophthalmol. Vis. Sci. 2018;59(9):849.
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To report a rare reaction after autologous RPE and choroid transplantation.
Report of two patients with a fovea involving RPE-tear after anti-VEGF treatment for their RPE detachment in AMD. Both suffered a deterioration of vision with particularly disabling metamorfopsia. Preop vision in the affected eye was 0.16 and 0.3 (Snellen notation) respectively.Surgery consisted of fako, vitrectomy, peripheral retinotomy, exposition of the temporal subretinal space, removal of the neovascular complex, with subsequent transposition of a midperipheral RPE and choiroid graft to the macula. The retina was repositioned over the graft and a silicone oil tamponade was left.
Silicone oil was removed in both after 2 months.Revascularization of the graft appeared to have occurred when assessed by SD-OCT.However, 4 to 6 months postop, we observed an unusual loss of the normal brown velvety aspect of the graft, changing into a leopard spot depigmentation.No hard exudates or hemorrhages were noted in the retina, nor inflammatory cells in the anterior chamber or vitreous cavity.On SD-OCT, we noted the presence of shallow subretinal fluid and the appearance of multiple hyperrefective spots in the outer retinal layers and on the RPE (Figure 1 and 2).Treatment with subconjunctival injections of triamcinolon acetate in both patients and 3 injections of bevazucimab in the patient with fibrovascular activity at the edge of the graft did not change the function or appearance of the RPE over a period of 6 months. At 12 month follow-up both patients retained their preop vision: 0.2 and 0.3, with fixation on the graft.
A gradual loss of RPE cells is a normal finding after an autologous RPE and choiroid graft. Usually, it resembles geographic atrophy..The hyperreflective spots on SD-OCT do not correspond to hard exudates and have been correlated with the presence of glial cell activation or a marker of inflammation. The spots at the level of the photoreceptors may represent elongated outer segments.Is this RPE phagocytosis as a reaction to a danger signal of the traumatized transplanted autologous cells ? We have no explanation why only these two patients would be so affected among the more than 480 such patients in Rotterdam and Verona 1,2.1.van Zeeburg EJ, van Meurs JC. Acta ophthalmologica 2014; 92: 228-31.2.van Romunde SHM, Pertile G. Retina Nov. 2017.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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