To evaluate the feasibility and initial functional and anatomical outcomes of transplanting a full-thickness free graft of choroid and retinal pigment epithelium (RPE), along with neurosensory retina in advanced fibrosis and atrophy associated with end-stage exudative age-related macular degeneration with and without a concurrent refractory macular hole.
During vitrectomy, an RPE–choroidal and neurosensory retinal free graft was harvested in nine eyes of nine patients. The RPE–choroidal and neurosensory retinal free graft was either placed subretinally (n = 5), intraretinally to cover the foveal area inside an iatrogenically induced macular hole over the RPE–choroidal graft (n = 3) or preretinally (n = 1) without a retinotomy wherein both free grafts were placed over the concurrent macular hole. Silicone oil endotamponade was used in all cases.
Mean follow-up was 7 ± 5.5 months (range 3–19). The mean preoperative visual acuity was ∼count fingers (logarithm of the minimum angle of resolution = 2.11, range 2–3), which improved to ∼20/800 (logarithm of the minimum angle of resolution 1.62 ± 0.48, range 0.7–2, P = 0.04). Vision was stable in 5 eyes (55.6%) and improved in 4 eyes (44.4%). Reading ability improved in 5 eyes (55.6%). Postoperative complications were graft atrophy (n = 1), epiretinal membrane (n = 1), and dislocation of neurosensory retina–choroid–RPE free graft (n = 1).
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.
The authors demonstrate the feasibility of transplanting a full-thickness autologous free graft of choroid and retinal pigment epithelium, along with neurosensory retina in eyes with advanced fibrosis and atrophy in end-stage exudative age-related macular degeneration including the presence of an associated refractory macular hole. Some degree of functional improvement was noted in 55.6% eyes.
*Department of Ophthalmology, Sant′Anna Institute, Brescia, Italy; and
†Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
Reprint requests: Barbara Parolini, MD, Istituto Clinico S.Anna, Via del Franzone, 31, 25127 Brescia, Italy; e-mail: firstname.lastname@example.org
Paper presented at the Duke Advanced Vitreous Surgery Course Meeting, April 21, 2017, Durham, North Carolina.
All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. T. H. Mahmoud reports participation in an advisory board for Dutch Ophthalmic (Exeter, NH), Alimera, and Spark Therapeutics and as a research support as investigator for Genentech. D. S. Grewal reports participation in an advisory board for Allergan and Regeneron. The remaining authors have no conflict of interest to disclose.
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The authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.