Retinal pigment epithelium and choroid translocation in patients with exudative age-related macular degeneration: long-term results

Abstract

Background To study the results of the translocation of a free autologous retinal pigment epithelium (RPE)-choroid graft after removal of a subfoveal choroidal neovascular membrane in patients with exudative age-related macular degeneration (AMD), and to determine whether preoperative variables may predict visual outcome at 1 year after surgery. Methods Prospective interventional case series of 84 eyes of 83 consecutive eligible patients with exudative AMD with a minimal follow-up of 1 year after surgery. Of this group, 45, 24 and 11 patients reached a follow-up of respectively 2, 3 and 4 years. Pre-and postoperative evaluation included ETDRS visual acuity (VA), fixation testing and color fundus photography. Preoperative fluorescein angiograms were assessed by masked readers for lesion size, size of hemorrhage and lesion composition according to the MPS criteria. The relationship between lesion composition adjusted for preoperative delay and VA, lesion size, percentage of blood, and visual outcome at 1 year after surgery was analyzed. Results The mean VA (logMAR) improved slightly at 1 and 2 years (0.89, Δ=−0.06), 3 years (0.79, Δ=−0.16) and 4 years (0.74, Δ=−0.21) after surgery. Five patients had a preoperative VA better than 20/80, compared to 19 out of 84, six out of 45, four out of 24 and two out of 11 after 1, 2, 3 and 4 years respectively. Fixation was located on the graft in 62 patients (74%) up to the last examination. Predominantly classic and occult lesions had a significant better prognosis than minimally classic or hemorrhagic (≥50% blood) lesions. Retinal detachment occurred in seven patients; two caused by rhegmatogenous detachment and five caused by proliferative vitreoretinopathy. In 11 eyes, a recurrent or persisting neovascular membrane was observed. Conclusion An autologous free RPE-choroid graft may stabilize or improve vision in patients with exudative AMD up to 4 years after surgery.

Long term visual and microperimetry outcomes following autologous retinal pigment epithelium choroid graft for neovascular age-related macular degeneration

“…Using various techniques to study fixation, previous studies have also shown 40 to 74% of eyes achieved fixation over the graft. [34][35][36][37][38][39] Similar to that reported by Maaijwee et al, we also found that fixation stability may worsen or improve during follow-up. 40 The reason for worsening of fixation stability may be related to delayed cystic change or atrophy whereas improvement in stability may be related to adaptation to eccentric fixation and viewing.…”

“…33 They found the mean VA improved from 0.95 logMAR at baseline to 0.89 logMAR at 1 and 2 years and 0.79 logMAR at 3 years (n = 84, 45 and 24 patients, respectively). They showed, with a Kaplan-Meier plot that the percentage of eyes loosing < 3 ETDRS lines was 70-80% at 1 year and stabilises at around 50% at 2 to 4…”

“…Maaijwee and colleagues reported that autologous RPE-choroid graft from the equator can stabilise or improve VA at 2 to 4 years. 14 However, VA is a measure of retinal function at the fixation locus and does not provide any information on the ability of the patch graft in supporting central visual field. An alternative method is to measure local retinal sensitivity over the region of the graft using Nidek MP 1 microperimeter.…”

25th RCOphth Congress, President's Session paper: 25 years of progress in vitreoretinal surgery

“…The peripheral RPE patches seem to have good long-term survival, and the visual results are reasonable. 61 The introduction of anti-VEGFs revolutionised the treatment of CNV in ARMD, and the indications for vitreoretinal surgery reduced considerably. There are a few remaining indications such as RPE rips and subretinal haemorrhages, but very few cases are being done.…”

High efficiency non-viral transfection of retinal and iris pigment epithelial cells with pigment epithelium-derived factor

“…[1][2][3][4][5][6][7][8][9] Since in vivo an equilibrium of neurotrophic factors, such as pigment epithelium-derived factor (PEDF), fibroblast growth factor, platelet-derived growth factor and others, supports the survival of neural tissues, it may be necessary to transplant cells that have been genetically modified to express these factors to achieve optimal functional improvement. In fact, in vitro and in vivo studies have shown that supplementation with various growth factors prevents or delays photoreceptor degeneration and increases the function of dopaminergic tissue in animal models of retinal degeneration and PD.…”