Original article
Autologous retinal pigment epithelium and choroid translocation in patients with exudative age-related macular degeneration: short-term follow-up

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Abstract

Purpose

To evaluate the feasibilty of translocating autologous retinal pigment epithelium cells and choroid after the removal of a subfoveal choroidal neovascular membrane in patients with exudative age-related macular degeneration.

Design

Interventional case series.

Methods

This was a prospective evaluation of six patients with a follow-up of 7 to 13 months. All patients had large (> 1 disk diameter) subfoveal choroidal membranes, five with subretinal hemorrhage. Preoperative visual acuity ranged from 20/400 to 20/200. After the extraction of the neovascular complex, an autologous peripheral full-thickness patch of retinal pigment epithelium, Bruch membrane, choriocapillary, and choroid was cut out from the midperiphery and repositioned under the macula. Functional tests included Early Treatment Diabetic Retinopathy Study vision testing, fixation testing on a optical coherence tomography monitor, fluorescein and indocyanine green angiography, and scanning laser ophthalmoscopy autofluorescence.

Results

The retinal pigment epithelium patch appeared flat and had a brown furry aspect in four patients. Fixation was on the patch in these four patients. Postoperative vision ranged from 20/200 to 20/64, with a 2-line increase in three patients. Revascularization was visible on fluorescein and indocyanide angiography in three patients examined in this manner. Normal retinal pigment epithelium autofluorescence was present over the patch in four patients.

Conclusions

The translocation of a full-thickness patch with autologous peripheral retinal pigment epithelium to the macula after choroidal neovascular membrane extraction was feasible and may result in a surviving and functioning graft for more than 1 year. Longer follow-up to evaluate its long-term benefit is necessary, as well as refinement of the surgery.

Section snippets

Methods

Patients with a subfoveal choroidal neovascular membrane that was more than 50% occult on fluorescein angiography and larger than 1 disk diameter, with or without submacular blood, were eligible for retinal pigment epithelium translocation. Fourteen patients have been included from October 12, 2001, but only the first six were followed up for more than 7 months. This study had been approved by the Institutional Review Board of the Rotterdam Eye Hospital and written informed consent was obtained

Results

The preoperative duration of visual loss in the operated eye ranged from 2 weeks to 4 months. Visual acuity ranged from 20/400 to 20/200. End-stage macular degeneration was present in the fellow eye in five patients (Table 1).

On fluorescein angiography five patients had a mixed or occult subfoveal neovascularization; in 1 patient (Patient 1) no angiogram had been performed because of a thick submacular hemorrhage. On angiography the size of the neovascular membranes varied from 1 to 2 disk

Discussion

This study proved that translocation of a healthy patch of retinal pigment epithelium and choroid in the subfoveal area of patients with AMD can lead to improvement of visual acuity, central fixation, and normal retinal pigment epithelium autofluorescence for a period of more than 1 year. Fluorescein and indocyanine green angiography suggested the presence of a perfused choroid and choriocapillary in or under the graft. We speculate that some degree of perfusion of the graft occurred either by

References (30)

  • C.C. Klaver et al.

    Incidence and progression rates of age-related maculopathythe Rotterdam Study

    Invest Ophthalmol Vis Sci

    (2001)
  • Laser photocoagulation of subfoveal neovascular lesions in age-related macular degeneration. Results of a randomized clinical trial

    Arch Ophthalmol

    (1991)
  • F.G. Holz et al.

    Patterns of increased in vivo fundus autofluorescence in the junctional zone of geographic atrophy of the retinal pigment epithelium associated with age-related macular degeneration

    Graefes Arch Clin Exp Ophthalmol

    (1999)
  • F.G. Holz et al.

    Fundus autofluorescence and development of geographic atrophy in age-related macular degeneration

    Invest Ophthalmol Vis Sci

    (2001)
  • J.M. Converse et al.

    The vascularization of skin autografts and homograftsan experimental study in man

    Ann Surg

    (1956)
  • Cited by (0)

    InternetAdvance publication at ajo.com July 8, 2003.

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