Retinal pigment epithelium and choroid translocation in patients with age-related macular degeneration

Some patients with neovascular age-related macular degeneration (AMD) do not respond well to anti-vascular endothelial growth factor (VEGF) treatment, such as patients with fibrotic plaques, older organized subretinal hemorrhages, and retinal pigment epithelium (RPE) tears disrupting the subfoveal RPE. In such cases an autologous RPE and choroid transplant taken from the midperiphery can preserve macular function in some patients over a long period of time. Proliferative vitreoretinopathy and, rarely, fibrosis around the graft are the most severe postoperative complications. For dry AMD autologous RPE transplantation has not been proven to be of benefit. Future developments in stem cell-derived RPE may lead to better functional outcomes, but in the meantime, for patients with neovascular AMD, the postoperative challenges encountered in autologous transplant surgery remain. It is not yet clear whether the combination of RPE and choroid transplantation is mandatory for successful function, but a lack of revascularization of the latter has been shown to lead to atrophy of the overlying retina.