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Visual acuity of 20/32, 13 5 years after a retinal pigment epithelium and choroid
graft transplantation
#MMPMID29780916
van Zeeburg EJT
; Maaijwee KJM
; van Meurs JC
Am J Ophthalmol Case Rep
2018[Jun]; 10
(?): 62-64
PMID29780916
show ga
PURPOSE: To present the 13.5-year-survival of an autologous retinal pigment
epithelium (RPE) and choroid graft transplantation with good visual acuity
results. OBSERVATIONS: A 72-year old patient presented with a 5-weeks-old visual
acuity deterioration to excentric finger counting at half a meter. Fundoscopy
showed a fibrotic macular scar, a large subretinal hemorrhage, partly recent,
combined with intraretinal fluid, blood, and hard exudates. RPE-choroid graft
surgery was performed, and visual acuity improved to 20/32, and maintained up
until 13.5 years postoperative. Microperimetry performed at the same time
revealed a 3.4?dB sensitivity, with fixation on the graft. During the
postoperative years glaucoma developed, an uveitis anterior was treated, and to
treat a small Coats' like lesion; one bevacizumab injection was administered.
CONCLUSIONS AND IMPORTANCE: A best corrected visual acuity of 20/32 could be
achieved and maintained up to 13.5 years after an RPE-choroid graft
transplantation, despite an unfavorable preoperative presentation and some early
and late complications. This case is a proof of principle that an RPE-choroid
graft harvested from the midperiphery can support the macular metabolism up to
13.5 after surgery in a patient with severe exudative AMD. It also represents a
rationale for pursuing stem cell derived RPE replacement. Anti-vascular
endothelial growth factor injections are nowadays the mainstay of therapy for
choroidal neovascularization and/or small hemorrhages and offer good results.
Nevertheless, selected patients that cannot benefit from this therapy may profit
from an autologous RPE-choroid graft transplantation.