Autologous transplantation of retinal pigment epithelium-Bruch's membrane complex for hemorrhagic age-related macular degeneration.
OBJECTIVE
To evaluate a surgical procedure for patients with hemorrhagic age-related macular degeneration (AMD).


METHODS
This procedure consisted of excision of the choroidal neovascular membrane and transplantation of autologous retinal pigment epithelium (RPE)-Bruch's membrane complex. The RPE-Bruch's membrane complex for transplantation was surgically developed by dissecting Bruch's membrane with the choriocapillaris from the medium size choroidal vessel layer at the midperipheral region of the choroid. Twenty-one eyes of 21 patients had this surgical procedure. Visual function tests included best corrected visual acuity (BCVA), multifocal (mf)ERG, and microperimetry. Optical coherence tomography (OCT), fluorescein angiography, and autofluorescence examinations were performed to study the status of the transplanted graft.


RESULTS
Among the 21 eyes, 17 with complete clinical data and qualified follow-up durations, which were 20.35 +/- 10.31 months on average, were analyzed in this series. On the last follow-up visit, the mean for the ETDRS scores increased from 28.65 +/- 23.99 before surgery to 47.76 +/- 17.22 after surgery. Microperimetry showed that after surgery, seven eyes gained central fixation at the 12-month follow-up examination. However, two eyes lost their central fixation on the last follow-up visit. Fourteen (82.35%) of the transplanted patches preserved normal color without depigmentation. Among the 21 eyes, proliferative vitreoretinopathy (PVR) occurred in 3 (14.29%), and a recurrent neovascular membrane was observed in one eye (4.76%).


CONCLUSIONS
The transplantation of the autologous RPE-Bruch's membrane complex can increase the visual acuity of patients with hemorrhagic AMD. The surviving transplanted graft with functional overlying retina was observed after surgery.
Ma
Zhizhong
Z
Peking University Eye Center, Peking University Third Hospital, Beijing, Peoples Republic of China.
Han
Liang
L
Wang
Changguan
C
Dou
Hongliang
H
Hu
Yuntao
Y
Feng
Xuefeng
X
Xu
Yimin
Y
Wang
Zhiqiang
Z
Yin
Zhengqin
Z
Liu
Yuling
Y
D000368:Aged; D000369:Aged, 80 and over; D016570:Bruch Membrane / Q000637:transplantation*; D017690:Cell Transplantation; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D004596:Electroretinography; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D008268:Macular Degeneration / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012160:Retina / Q000503:physiopathology; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D055213:Retinal Pigment Epithelium / Q000637:transplantation*; D041623:Tomography, Optical Coherence; D014182:Transplantation, Autologous; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology