Surgery for CNV and autologous choroidal RPE patch transplantation: exposing the submacular space

  • Matteo Giuseppe CeredaEmail author
  • Barbara Parolini
  • Elisa Bellesini
  • Grazia Pertile
Retinal Disorders



To evaluate the feasibility of transplanting a full-thickness patch of choroid, choriocapillaries, Bruch’s membrane and RPE (RPE-choroid FTAP) from the peripheral to the subfoveal area of the same eye, after performing a 180° peripheral retinotomy and removing subfoveal choroidal neovascularization. Thereafter, to study the surgical complications, anatomical outcome and patch perfusion during follow-up.


A retrospective case series of 13 eyes of 13 consecutive patients with a follow-up of 4 to 20 months. All patients suffered from advanced subfoveal choroidal neovascularization and were non-responders to standard care. After performing a complete vitrectomy, a 180° peripheral temporal retinotomy and the removal of subfoveal neovascularization, a FTAP of choroid, choriocapillaris, Bruch’s membrane and the RPE were isolated from the mid periphery of the uveal bed, transpositioned under the fovea and covered with the retina. Patients received a complete ophthalmic examination, fluorescein angiography (FA), indocyanin green angiography (ICGA) and optical coherence tomography (OCT) during follow-up.


An FTAP could be harvested in every eye and transplanted under the fovea. No intraoperative complications occurred. The FTAP was recognizable at FA, ICGA and OCT at each time point, up to 20 months postoperatively. Perfusion of the choroidal bed were observed into the FTAP during follow-up, from one week after surgery.


The creation of an FTAP through a 180° peripheral retinotomy is feasible and safe. The FTAP is vital and perfused. Further studies are needed to collect more data.


RPE translocation OCT Fluorescein angiography Indocyanin angiography AMD CNV removal 


  1. 1.
    Bressler NM, Bressler SB, Fine SL (1998) Age related macular degeneration. Surv Ophthalmol 32(6):375–413CrossRefGoogle Scholar
  2. 2.
    Guyer DR, Fine SL, Maguire MG et al (1986) Subfoveal choroidal neovascular membranes in age related macular degeneration: visual prognosis in eyes with relatively good initial visual acuity. Arch Ophthalmol 104(5):702–705PubMedGoogle Scholar
  3. 3.
    Virgili G, Bini A (2007) Laser photocoagulation for neovascular age-related macular degeneration. Cochrane Database Syst Rev Jul 18:CD004763Google Scholar
  4. 4.
    Verteporfin In Photodynamic Therapy Study Group (2001) Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: two-year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization—Verteporfin in Photodynamic Therapy Report 2. Am J Ophthalmol 131(5):541–560CrossRefGoogle Scholar
  5. 5.
    Hurwitz H, Fehrenbacher L, Novotny W et al (2004) Bevacizumab plus irinotecan, fluorouracil and leucovorin for metastatic colorectal cancer. N Engl J Med 350(23):2335–2342CrossRefPubMedGoogle Scholar
  6. 6.
    Moshfeghi AA, Rosenfeld PJ, Puliafito CA et al (2006) Systemic Bevacizumab (Avastin) therapy for neovascular age-related macular degeneration: twenty-four week results of an uncontrolled open-label clinical study. Ophthalmology 113(11):2002.e1–2002.e12CrossRefGoogle Scholar
  7. 7.
    Avery RL, Pieramici DJ, Rabena MD, Castellarin AA, Nasir MA, Giust MJ (2006) Intravitreal Bevacizumab (Avastin) for neovascular age-related macular degeneration. Ophthalmology 113(3):363.e5–372.e5CrossRefGoogle Scholar
  8. 8.
    Spaide RF, Laud K, Fine HF et al (2006) Intravitreal Bevacizumab treatment of choroidal neovascularization secondary to age related macular degeneration. Retina 26(4):383–390CrossRefPubMedGoogle Scholar
  9. 9.
    Gragoudas ES, Adamis AP, Cunnigham ET Jr et al (2004) VEGF inhibition study in ocular neovascularization clinical trial group. Pegaptanib for neovascular age-related macular degeneration. N Engl J Med 351(27):2805–2816CrossRefPubMedGoogle Scholar
  10. 10.
    Rosenfeld PJ, Brown DM, Heier JS et al, MARINA Study Group (2006) Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 355(14):1419–1431CrossRefPubMedGoogle Scholar
  11. 11.
    Brown DM, Kaiser PK, Michels M et al (2006) ANCHOR study group. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med 355(14):1432–1444CrossRefPubMedGoogle Scholar
  12. 12.
    Bressler NM, Bressler SB, Childs Al et al, Submacular Surgery Trials (SST) Research Group (2004) Surgery for haemorrhagic choroidal neovascular lesions of age-related macular degeneration: ophthalmic findings: SST report No. 13. Ophthalmology 111(11):1993–2006CrossRefPubMedGoogle Scholar
  13. 13.
    Pertile G, Claes C (2002) Macular translocation with 360 degree retinotomy for management of age-related macular degeneration with subfoveal choroidal neovascularization. Am J Ophthalmol 134(4):560–565CrossRefPubMedGoogle Scholar
  14. 14.
    Aisenbrey S, Bartz-Schmidt KU, Walter P et al (2007) Long term follow-up of macular translocation with 360 degrees retinotomy for exudative age-related macular degeneration. Arch Ophthalmol 125(10):1367–1372CrossRefPubMedGoogle Scholar
  15. 15.
    Lüke M, Ziemssen F, Völker M et al (2009) Full macular translocation (FMT) versus photodynamic therapy (PDT) with verteporfin in the treatment of neovascular age-related macular degeneration: 2-years results of a prospective, controlled, randomised pilot trial (FMT-PDT). Graefes Arch Clin Exp Ophthalmol 247(6):745–754CrossRefPubMedGoogle Scholar
  16. 16.
    Wong D, Stanga P, Briggs M et al (2004) Case selection in macular relocation surgery for age related macular degeneration. Br J Ophthalmol 88(2):186–190CrossRefPubMedGoogle Scholar
  17. 17.
    Gelisken F, Karim-Zoda K, Grisanti S, Bartz-Schmidt KU (2005) Macular translocation with 360 degrees retinotomy for retinal pigment epithelial tear. Graefes Arch Clin Exp Ophthalmol 243(6):619–621CrossRefPubMedGoogle Scholar
  18. 18.
    Binder S, Krebs I, Hilgers RD et al (2004) Outcome of transplantation of autologous retinal pigment epithelium in age-related macular degeneration: a prospective trial. Invest Ophthalmol Vis Sci 45(11):4151–4160CrossRefPubMedGoogle Scholar
  19. 19.
    Stanga PE, Kychenthal A, Fitze FW et al (2002) Retinal pigment epihelium translocation after choroidal neovascular membrane removal in age related macular degeneration. Ophthalmology 109:1492–1498CrossRefPubMedGoogle Scholar
  20. 20.
    Van Meurs JC, Van den Biesen PR (2003) Autologous retinal pigment epithelium and choroid translocation in patients with exudative age related macular degeneration: short term follow up. Am J Ophthalmol 136:688–695CrossRefPubMedGoogle Scholar
  21. 21.
    Maaiwee K, Heimann H, Missotten E et al (2007) Retinal pigment epithelium and choroid translocation in patients with exudative age-related maular degeneration: long-term results. Graefes Arch Clin Exp Ophthalmol 245:1681–1689CrossRefGoogle Scholar
  22. 22.
    Da Cruz L, Chen FK, Ahmado A et al (2007) RPE transplantation and its role in retinal disease. Prog Retin Eye Res 26:598–635CrossRefPubMedGoogle Scholar
  23. 23.
    Maaijwee K, Joussen AM, Kirchhof B, Van Meurs JC (2008) Retinal pigment epithelium (RPE)–choroid graft translocation in the treatment of an RPE tear: preliminary results. Br J Ophthalmol 92:526–529CrossRefPubMedGoogle Scholar
  24. 24.
    De Juan E, Jr LA, Bresler NM, Alexander J (1998) Translocation of the retina for management of subfoveal choroidal neovascularization, II: a preliminary report in humans. Am J Ophthalmol 125:635–646CrossRefPubMedGoogle Scholar
  25. 25.
    Holz FG, Bellmann C, Margaritidis M et al (1999) Patterns of increased in vivo fundus autofluorescence in the junctional zone of geographic atrophy of the retinal pigment epithelium associated with age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 237:147–152CrossRefGoogle Scholar
  26. 26.
    Delori FC, Dorey CK, Staurenghi G et al (1995) In vivo fluorescence of the ocular fundus exhibits retinal pigment epithelium characteristics. Invest Ophthalmol Vis Sci 36:718–729PubMedGoogle Scholar
  27. 27.
    Maaijwee K, Van Den Biesen PR, Missotten T et al (2008) Angiographic evidence for revascularization of an rpe–choroid graft in patients with age-related macular degeneration. Retina 28:498–503CrossRefPubMedGoogle Scholar
  28. 28.
    Yannuzzi LA, Negrao S, Ida T et al (2001) Retinal angiomatous proliferation in age-related macular degeneration. Retina 21(5):416–434CrossRefPubMedGoogle Scholar
  29. 29.
    Zhizhong MA, Lian H, Changguan W et al (2008) Autologous transplantation of retinal pigment epithelium-Bruch’s membrane complex for hemorrhagic age-related macular degeneration. Invest Ophthalmol Vis Sci 50(6):2975–2981. doi: 10.1167/iovs.08-2573 Google Scholar
  30. 30.
    Gibran SK, Romano MR, Wong D (2009) Perfluorocarbon liquid assisted large retinal epithelium patching in sub-macular hemorrage secondary to age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 247:187–191CrossRefPubMedGoogle Scholar
  31. 31.
    De Queiroz JM, Blanks JC, Ozler SA et al (1992) Subretinal perfluorocarbon liquids. Retina 12(3):S33–S39CrossRefPubMedGoogle Scholar
  32. 32.
    Joussen AM, Joeres S, Fawzy N et al (2007) Autologous translocation of the choroid and retinal pigment epithelium in patients with geographic atrophy. Ophthalmol 114:551–560CrossRefGoogle Scholar
  33. 33.
    Maajiwee KJM, Van Meurs JC, Kirchhof B et al (2007) Histological evidence for neovascularisation of an autologous pigment epithelium–choroid graft in the pig. Br J Ophthalmol 91:546–550CrossRefGoogle Scholar
  34. 34.
    Converse JM, Rapaport FT (1956) The vascularisation of skin autografts and homografts. Ann Surg 120:306–316CrossRefGoogle Scholar
  35. 35.
    Treumer F, Bunse A, Clatt C et al (2007) Autologous retinal pigment epithelium–choroid sheet transplantation in age related macular degeneration: morphological and functional results. Br J Ophthalmol 91:349–353CrossRefPubMedGoogle Scholar
  36. 36.
    McLaren RL, Balaggan KS, Milliken AB et al (2007) Autologous transplantaion of retinal pigment epithelium and choroid in the treatment of neovascular age-related macular degeneration. Ophthalmol 114:561–570CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Matteo Giuseppe Cereda
    • 1
    • 2
    Email author
  • Barbara Parolini
    • 1
  • Elisa Bellesini
    • 1
  • Grazia Pertile
    • 1
  1. 1.Department of OphthalmologyOspedale Sacro CuoreNegrarItaly
  2. 2.Via Don SempreboniNegrarItaly

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