Long-term visual and microperimetry outcomes following autologous retinal pigment epithelium choroid graft for neovascular age-related macular degeneration.
BACKGROUND
To describe the 2- to 4-year visual and microperimetry outcomes of autologous retinal pigment epithelium (RPE)-choroid graft in patients with neovascular age-related macular degeneration (AMD).


METHODS
In this retrospective cohort study, 12 patients with subfoveal neovascular AMD who had undergone autologous RPE-choroid graft between August 2004 and June 2005 were reviewed. Change in visual acuity (VA), contrast sensitivity (CS), fixation stability and retinal sensitivity on microperimetry after 2-3 years and the rates of late postoperative complications were examined.


RESULTS
Patients were followed for 26-48 months (mean, 39). Median preoperative VA (logMAR) was 0.87 but declined to 1.43 (1 year), 1.46 (2 years) and 1.38 (3 years), P = 0.001. Median CS (logCS) was 0.75 preoperatively but declined to 0.45 at 2 years. Six patients had serial microperimetry. Fixation stability declined in 1 but improved in 2 patients. All 6 had decline in retinal sensitivity over the graft during follow up. Retinal detachment did not occur after 12 months but 8 developed epiretinal membrane, 12 had cystic retinal change over the graft and 4 developed recurrent choroidal neovascularization. However, 10 grafts retained autofluorescence signal at 18-48 months of follow up.


CONCLUSIONS
Autologous RPE-choroid graft can maintain VA, stable fixation and retinal sensitivity in some patients for over 3 years. The spatial correlation between graft autofluorescence, outer retinal structures on optical coherence tomography and retinal sensitivity are consistent with photoreceptor cell rescue. However, we caution the use of this technique as there is high complication rate and delayed loss of retinal function.
Chen
Fred K
FK
Moorfields Eye Hospital, London, UK. fred.chen@moorfields.nhs.uk
Uppal
Gurmit S
GS
MacLaren
Robert E
RE
Coffey
Peter J
PJ
Rubin
Gary S
GS
Tufail
Adnan
A
Aylward
G William
GW
Da Cruz
Lyndon
L
D000368:Aged; D000369:Aged, 80 and over; D002829:Choroid / Q000473:pathology / Q000637:transplantation*; D020256:Choroidal Neovascularization / Q000150:complications / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D015350:Contrast Sensitivity; D006801:Humans; D008268:Macular Degeneration / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D012163:Retinal Detachment / Q000209:etiology; D055213:Retinal Pigment Epithelium / Q000473:pathology / Q000637:transplantation*; D012189:Retrospective Studies; D013995:Time; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D058609:Visual Field Tests