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


METHODS
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.
D000368:Aged; D000369:Aged, 80 and over; D016570:Bruch Membrane / Q000502:physiology / Q000637:transplantation; D002829:Choroid / Q000502:physiology / Q000637:transplantation*; D004396:Coloring Agents; D005122:Exudates and Transudates; D005240:Feasibility Studies; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007208:Indocyanine Green; D007368:Interferometry; D008268:Macular Degeneration / Q000601:surgery*; D008297:Male; D009887:Ophthalmoscopy; D010857:Pigment Epithelium of Eye / Q000502:physiology / Q000637:transplantation*; D011446:Prospective Studies; D014054:Tomography; D014182:Transplantation, Autologous; D014792:Visual Acuity / Q000502:physiology
D004396:Coloring Agents; D007208:Indocyanine Green