Autologous translocation of large retinal pigment epithelium choroid patches in age-related macular degeneration

Abstract

Background: The latest development in ARMD surgery is the translocation of an autologeous pigment epithelium choroid patch. The method has technical shortcomings: The transplant is excised including the overlaying retina and inserted through a retinotomy near the posterior pole thus causing iatrogenic field defects. For the same reasons the size of the transplant is limited. Materials and Methods: The technique was modified as follows: lens surgery using a special PCL with equal power in water and silicone oil, 180 degrees retinotomy just at the temporal ora serrata, subretinal surgery including patch transplantation with the retina folded over nasally and fixed by PFCL, complete silicone oil tamponade without any water remaining. Patients: 12 consecutive cases, age 79 (70-86) years, 4 RPE detachments and rips, 8 subretinal hemorrhages from wet ARMD, follow-up in 10 eyes over 15.3 (3-23) months. Time courses for visual acuity, depth of central scotoma, OCT and FAG. Results: The mean diameter of the transplants was 16.5 (9-33)degrees. Silicone explantation in 7/10. Complications in 3/10: 1 macula puckering, 1 peripheral detachment, 1 PVR detachment. According to FAG the transplant vascularises in 46 weeks. 4/10 eyes reached visual acuity > 0.2 with limited reading capability. Central scotoma depth remained constant at -11 dB. Function deteriorated again after 6-9 months with cystoid degeneration and retinal thickening. 8/11 patients estimated the operated eye to be superior to the untreated partner eye. Conclusions: Patch transplantation is able to restore limited reading capability in eyes having minor damage of the central retina. The best cases for this type of operation are RPE rips and recent sub-RPE haemorrhages. The functional success lasts 5 to 9 months, then the retina over the transplant begins to degenerate.