Autologous choroidal transplantation may lead to successful results in select AMD cases

Autologous choroidal transplantation may lead to successful outcomes in select patients with age-related macular degeneration who are refractory to anti-VEGF therapy.

Dr. Grazie Pertile, who was presenting at the Bassano Ophthalmology Meeting, said that cases of large subretinal hemorrhage and RPE rupture involving the fovea, or patients who do not respond to anti-VEGF with any of the available drugs may benefit from this treatment.

Selection for surgery is made based on OCT to assess whether the external layers of the retina are still viable. Patients should be healthy enough to undergo an operation of about 1.5 hours under general anesthesia and have a good potential to regain vision.

The aim of this surgery is to replace the damaged layer under the retina with a healthy patch of choroid harvested from the healthy mid-periphery of the same eye, providing a healthier substrate to nourish the retina. Rapid choroidal reperfusion should occur to make this surgery successful. After complete vitrectomy, the retina is lifted temporally and a peripheral retinotomy of 180° or more is performed. The area of transplantation is marked with the laser, choroidal neovascularization is removed, and the tailored retinal pigment epithelium and choroid patch is placed in the subfoveal area. The choroidal patch should be harvested from an area far enough from the area of transplantation to avoid fibrotic reactions.

Since 2006, Dr. Pertile has treated 120 patients with this technique. Results have been variable, but some degree of visual improvement has been seen in all eyes and some patients were able to regain 20/20 vision. Complications occurred in less than 10% of cases.

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