- Thursday 26 Jan 2023, 10:30 - 12:00
- PhD defence
- Senate Hall
- Erasmus Building
- Campus Woudestein
S.H.M. van Romunde will defend her PhD dissertation on Thursday 26 January 2023, entitled: ’Surgical Treatment for Exudative Age-related Macular Degeneration‘.
Background: Submacular surgery for exudative age-related macular (AMD, i.e. full macular translocation (FMT) and retinal pigment epithelium (RPE-) choroid transplantation, is reserved for cases that do not benefit from standard treatment. The aim of this thesis was to study the long-term results of both surgical interventions, the morphological changes after FMT, and a potential immune response after RPE-choroid transplantation.
Results: A retrospective study regarding FMT including 158 patients with a mean follow-up of 45 months showed a significant visual gain five years postoperatively. A retrospective study of 81 patients that underwent RPE-choroid transplantation with a mean follow-up of 38 months showed a ≥3 line improvement in 53% of the patients after one year, and in 46% at last visit. Morphological change after FMT was evaluated in 51 patients with a mean follow-up of 30 months. The visibility of the external limiting membrane (ELM) increased in 29%. The most important predictive factors for a favourable outcome was the presence of ELM. Five patients had a destructive inflammatory reaction after uncomplicated RPE-choroid transplantation. When testing for RPE-antibodies, we found no evidence for an auto-immune origin.
Conclusion: After submacular surgery, some of the morphology and function can be restored. Extrafoveal RPE seems to be able to sustain the fovea, also in the long-term. The most important predictive factor for surgical outcome is the integrity of the ELM. We observed five cases of inflammatory reaction after RPE-choroid transplantation, even though the graft was autologous. However, we were unable to pinpoint what elicited this reaction.