gms | German Medical Science

Purpose: To report and analyze long-term best corrected visual acuity (BCVA) outcomes following a free autologous retinal pigment epithelium (RPE)-choroid graft translocation in patients with exudative age-related macular degeneration (AMD).

Study population: One hundred and thirty consecutive patients (133 eyes) with AMD who underwent RPE-choroid graft translocation between October 2001 and February 2006. The patients had a subfoveal choroidal neovascular membrane with or without blood and/or an RPE-tear and were not eligible for or non responsive to, standard treatment at that time: photodynamic therapy.

Observation procedures: Data collection included pre- and postoperative visual acuity measurements, fundus photography, fluorescein and indocyanine green angiography, and microperimetry.

Main Outcome Measures: Postoperative BCVA.

Results: The mean preoperative BCVA was 20/250. Four years after surgery, 15% of the eyes had a BCVA of >20/200, and 5% had a BCVA of =20/40. One patient maintained a BCVA of 20/32 up to seven years after surgery. Complications consisted of proliferative vitreoretinopathy (PVR) (n=13), recurrent neovascularisation (n=13) and hypotony (n=2).

Conclusions: An RPE-choroid graft can survive for up to 7 years after surgery, with relatively low complication and recurrence rates. Our results in terms of BCVA and microperimetry suggest that the RPE-choroid graft rather than just removal of submacular hemorrhage and choroidal neovascular membrane was responsible for the preservation of some macular function. This surgery may be a viable alternative for patients with AMD who cannot undergo other, more standard, treatments. Tretament indications of the described cohort do not differ much from patients who would be candidates for surgery in 2011: patients with older large hemorrhages, RPOE tears and non-responders to anti-VEGF injections.