Evidence of retinal function using microperimetry following autologous retinal pigment epithelium-choroid graft in macular dystrophy: outcome in five cases
Fred K Chen 1*,
Gurmit S Uppal 2,
Gary S. Rubin 3,
Andrew Webster 4,
Peter J. Coffey 5,
and
Lyndon Da Cruz 6
1 Vitreoretinal Surgery, Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, United Kingdom; Cellular Therapy, UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, United Kingdom
2 Vitreoretinal Surgery, Moorfields Eye Hospital, London, United Kingdom
3 Vision Rehabilitation, UCL Institute of Ophthalmology, London, United Kingdom; Biomedical Research Centre for Ophthalmology, National Institute for Health Research , London, United Kingdom
4 Genetics, UCL Institute of Ophthalmology, London, United Kingdom
5 Cellular Therapy, UCL Institute of Ophthalmology, London, United Kingdom
6 Vitreoretinal Surgery, Moorfields Eye Hospital, London, United Kingdom; Cellular Therapy, UCL Institute of Ophthalmology, London, United Kingdom
* To whom correspondence should be addressed. E-mail: fkchen02{at}yahoo.com.
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Abstract |
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Purpose. To describe the outcomes of autologous retinal pigment epithelium (RPE)-choroid graft in macular dystrophy.
Methods. In this prospective interventional case series, 5 patients with macular dystrophy were enrolled to undergo autologous RPE-choroid patch graft between August 2005 and January 2007. All patients received pre- and post-operative evaluations including visual acuity, contrast sensitivity, reading ability, microperimetry, fluorescein and indocyanine green (ICG) angiographies, fundus autofluorescence (AF) imaging and optical coherence tomography (OCT).
Results. Patients were followed for an average of 13.4 (9 to 23) months. Two patients gained reading acuity but only one regained visual task function following graft. This was maintained for about 12 months. Although there is an overall loss of visual acuity, contrast sensitivity and reading ability, postoperative microperimetry demonstrated retinal sensitivity over the graft in all patients with maximum sensitivity, using a Goldmann size III stimulus of 200 ms duration, ranging from 12 to 20 dB. Postoperatively, one patient developed retinal detachment and 2 required cataract extraction at the time of removal of oil. ICG angiography demonstrated perfusion of the graft in 4 patients. With image registration, homogenous AF pattern in areas of the graft was found to be associated with presence of retinal sensitivity.
Conclusions. Autologous RPE-choroid graft can be performed in patients with macular dystrophy. Although microperimetry showed evidence of retinal function over a perfused and autofluorescent graft , the overall loss of visual acuity and reading ability raises concerns over the use of this novel surgical technique in these patients.
Key Words:
retinal dystrophy, retinal pigment epithelium, retinal transplantation, surgery, microperimetry, autofluorescence
