Combined Autologous Transplantation of Neurosensory Retina, Retinal Pigment Epithelium, and Choroid Free Grafts

Abstract

Combined autologous RPE-choroid and neurosensory retinal free graft is a potential surgical alternative in eyes with end-stage exudative age-related macular degeneration, including concurrent refractory macular hole.

Autologous neurosensory retinal transplantation for recurrent macular hole retinal detachment in highly myopic eyes

“…However, we found that the corresponding area of the graft was consistently dark during follow-up MAIA examination, whereas the retinal sensitivity gradually increased on the nasal side and upper part of the macular fovea with gradual appearance of stable paracentral fixation. We could not detect the blood flow signal in the deep or superficial layer of the retinal graft on OCT angiography, which is consistent with the report by Parolini et al (2018). We hypothesize that the improvement in vision postoperatively may be the result of closure of the MH, retinal reattachment and gradual development of paracentral fixation.…”

“…There were no cases of reopening of the MH or recurrence of retinal detachment in the 3 months after silicone oil extraction. Thomas & Mahmoud (2018) and Parolini et al (2018) also described gradually merging of a neurosensory retinal graft with the surrounding retinal tissue and disappearance of the boundary. In our present retrospective case series, 1 eye (case 3) showed partial displacement of the graft.…”

“…Blood that permeates into the subretinal space may also promote release of fibrin degradation products that are toxic to the retina (Glatt & Machemer 1982). Thomas & Mahmoud (2018) and Parolini et al (2018) placed the retinal graft under the retina in the macular region and believed that the metabolic exchange of the graft could be optimized beside the choroidal circulation, which was considered feasible in the case of retinal detachment accompanied by PVR requiring retinotomy. Wu et al (2018) believed that the retinal graft should be similar in size to the MH, thereby serving as an MH filler and as a bridge and scaffold for proliferation of glial cells.…”

“…Hayashi & Kuriyama, (2014) suggested that irreversible damage to the photoreceptor cells has already occurred and is not recoverable after reattachment of the retina. Parolini et al (2018) combined an autologous RPE choroid with a neurosensory retinal graft for the treatment of end-stage age-related macular Fig. 3.…”

Applications of the Amniotic Membrane in Vitreoretinal Surgery

“…In recent times, interesting new surgical treatments have been suggested for end-stage AMD. Autologous retinal and chorioretinal transplants have been proposed by Dr Parolini [ 64 ]. However, the autologous choroidal and retinal transplants are technically challenging procedures with a high risk of intra-operative and post-operative complications, such as retinal detachment with proliferative vitreoretinopathy.…”