In this video, Grazia Pertile, MD, head of the Ophthalmology Department of Negrar Hospital, Italy, presents her personal technique of autologous choroidal transplantation, a surgical procedure that may benefit selected cases of advanced age-related macular degeneration that do not respond to anti-VEGF treatment.
“We cannot transplant the retina but can replace the damaged layer under the retina with a healthy patch of choroid, providing a healthier substrate to nourish the retina,” Pertile said.
This surgery should be reserved for selected patients who have gained no benefit from anti-VEGFs even after a switch and who typically present with complications such as large subretinal hemorrhage or retinal pigment epithelium tears and continue to lose vision. They also need to be relatively healthy, cooperative patients who can undergo a lengthy surgery of 1.5 to 2 hours under general anesthesia.
Integrity of the photoreceptor layers, assessed preoperatively by OCT, is a condition for the success of this surgery.
“We may be able to rescue a retina that needs reanimation but cannot resuscitate a dead retina,” Pertile said.
She offered the following advice for the surgery:
- The use of 20-gauge instruments offers some advantages, because curved scissors make the peripheral retinotomy to gain access to the subretinal space and the preparation of the choroidal patch faster and safer.
- Use a bimanual technique because both hands are needed for this delicate, complex surgery.
- In order to do so, use an independent light source.
- Perform the retinotomy far in the periphery to reduce the risk of proliferative vitreoretinopathy.
- Mark the choroidal patch with the laser to ensure the desired shape is cut.
Fast reperfusion of the choroid is a sign of successful surgery. Delayed reperfusion may lead to retinal damage and poor results.
Since 2006, 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. Serious complications occurred in less than 10% of cases. – by Michela Cimberle