PhD defence S.H.M. (Saskia) van Romunde

Summary:

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.