Evidence of retinal function using microperimetry following autologous retinal pigment epithelium-choroid graft in macular dystrophy.
OBJECTIVE
To describe the outcomes of autologous retinal pigment epithelium (RPE)-choroid graft in macular dystrophy.


METHODS
In this prospective interventional case series, five patients with macular dystrophy were enrolled to undergo autologous RPE-choroid patch graft between August 2005 and January 2007. All patients received preoperative and postoperative evaluations including visual acuity, contrast sensitivity, reading ability, microperimetry, fluorescein angiography, indocyanine green angiography, fundus autofluorescence (AF) imaging, and optical coherence tomography (OCT).


RESULTS
Patients were followed up for an average of 13.4 (9-23) months. Two patients gained reading acuity but only one regained visual task function after graft. This was maintained for approximately 12 months. Although there is an overall loss of visual acuity, contrast sensitivity, and reading ability, postoperative microperimetry demonstrated retinal sensitivity over the graft in all patients with maximum sensitivity, using a Goldmann size III stimulus of 200-ms duration, ranging from 12 to 20 dB. After surgery, one patient developed retinal detachment and two required cataract extraction at the time of removal of oil. ICG angiography demonstrated perfusion of the graft in four patients. With image registration, homogenous AF pattern in areas of the graft was found to be associated with retinal sensitivity.


CONCLUSIONS
Autologous RPE-choroid graft can be performed in patients with macular dystrophy. Although microperimetry showed evidence of retinal function over a perfused and autofluorescent graft, the overall loss of visual acuity and reading ability raises concerns over the use of this novel surgical technique in these patients.
Chen
Fred K
FK
Moorfields Eye Hospital, London, United Kingdom. fkchen02@yahoo.com
Uppal
Gurmit S
GS
Rubin
Gary S
GS
Webster
Andrew R
AR
Coffey
Peter J
PJ
Da Cruz
Lyndon
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D002829:Choroid / Q000637:transplantation*; D015350:Contrast Sensitivity; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green; D008266:Macula Lutea; D008297:Male; D008875:Middle Aged; D010857:Pigment Epithelium of Eye / Q000637:transplantation*; D010865:Pilot Projects; D011183:Postoperative Complications; D011446:Prospective Studies; D011932:Reading; D012039:Regional Blood Flow; D012160:Retina / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D012164:Retinal Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D012171:Retinal Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014785:Vision, Ocular; D014792:Visual Acuity; D058609:Visual Field Tests
D007208:Indocyanine Green