Surgery for CNV and autologous choroidal RPE patch transplantation: exposing the submacular space.
BACKGROUND
To evaluate the feasibility of transplanting a full-thickness patch of choroid, choriocapillaries, Bruch's membrane and RPE (RPE-choroid FTAP) from the peripheral to the subfoveal area of the same eye, after performing a 180 degrees peripheral retinotomy and removing subfoveal choroidal neovascularization. Thereafter, to study the surgical complications, anatomical outcome and patch perfusion during follow-up.


METHODS
A retrospective case series of 13 eyes of 13 consecutive patients with a follow-up of 4 to 20 months. All patients suffered from advanced subfoveal choroidal neovascularization and were non-responders to standard care. After performing a complete vitrectomy, a 180 degrees peripheral temporal retinotomy and the removal of subfoveal neovascularization, a FTAP of choroid, choriocapillaris, Bruch's membrane and the RPE were isolated from the mid periphery of the uveal bed, transpositioned under the fovea and covered with the retina. Patients received a complete ophthalmic examination, fluorescein angiography (FA), indocyanin green angiography (ICGA) and optical coherence tomography (OCT) during follow-up.


RESULTS
An FTAP could be harvested in every eye and transplanted under the fovea. No intraoperative complications occurred. The FTAP was recognizable at FA, ICGA and OCT at each time point, up to 20 months postoperatively. Perfusion of the choroidal bed were observed into the FTAP during follow-up, from one week after surgery.


CONCLUSIONS
The creation of an FTAP through a 180 degrees peripheral retinotomy is feasible and safe. The FTAP is vital and perfused. Further studies are needed to collect more data.
Department of Ophthalmology, Ospedale Sacro Cuore, Negrar, Verona, Italy. matteo.cereda@gmail.com
Matteo Giuseppe
MG
Cereda
Barbara
B
Parolini
Elisa
E
Bellesini
Grazia
G
Pertile
D000368:Aged; D000369:Aged, 80 and over; D016570:Bruch Membrane / Q000637:transplantation*; D002829:Choroid / Q000637:transplantation*; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D004396:Coloring Agents; D005240:Feasibility Studies; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D012160:Retina / Q000601:surgery; D055213:Retinal Pigment Epithelium / Q000637:transplantation*; D012189:Retrospective Studies; D012827:Silicone Oils / Q000008:administration & dosage; D041623:Tomography, Optical Coherence; D014182:Transplantation, Autologous; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy
D004396:Coloring Agents; D012827:Silicone Oils; D007208:Indocyanine Green