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.

Additional Metadata
Keywords Choroid, Graft, Long-term, Microperimetry, Retinal pigment epithelium, Transplantation
Persistent URL dx.doi.org/10.1016/j.ajoc.2018.01.042, hdl.handle.net/1765/105501
Journal American Journal of Ophthalmology Case Reports
Citation
van Zeeburg, E.J.T, Maaijwee, K.J.M, & van Meurs, J.C. (2018). Visual acuity of 20/32, 13.5 years after a retinal pigment epithelium and choroid graft transplantation. American Journal of Ophthalmology Case Reports, 10, 62–64. doi:10.1016/j.ajoc.2018.01.042