Autotranslocation of the pigment epithelium-choroid complex in treatment of age-related macular degeneration scarring stage

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Abstract

The “gold standard” of the neovascular age-related macular degeneration treatment is the intravitreal administration of angiogenesis inhibitors. In subretinal macular fibrosis, antiangiogenic therapy is not effective. In such cases, subretinal surgery is used, in particular, autotranslocation of pigment epithelium-choroid complex. This paper presents a case of successful use of this method in a 77 y.o. female patient with subretinal fibrosis in the macular area as an outcome of neovascular age-related macular degeneration. An original method of translocation of “pedicled” pigment epithelium-choroid complex from the paramacular area to the macula was used. In 24 months, the visual acuity increased from 0.01 to 0.07; the central fixation was restored; the absolute positive central scotoma disappeared. During all the post-operative follow-up period, the full-rate pigment epithelium-choroid perfusion in the choroid of the translocated flap, the loss of choroidal neovascularization activity signs and of indications for intravitreal administration of angiogenesis inhibitors were proved.

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About the authors

Sergei V. Sosnovskii

Federal State Autonomous Institution “S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery” of the Ministry of Health of the Russian Federation

Author for correspondence.
Email: svsosnovsky@mail.ru
ORCID iD: 0000-0002-1745-5146

Assistant-Professor, PhD, MD of Highest Qualification

Russian Federation, Saint Petersburg

Ernest V. Boiko

Federal State Autonomous Institution “S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery” of the Ministry of Health of the Russian Federation; North-Western State Medical University named after I.I. Mechnikov; S.M. Kirov Military Medical Academy

Email: boiko111@list.ru

Professor, Doctor of Medical Science, Honored MD of Russian Federation, Director; Professor, Head, Ophthalmology Department

Russian Federation, Saint Petersburg

Dzhambulat Kh. Oskanov

Federal State Autonomous Institution “S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery” of the Ministry of Health of the Russian Federation

Email: oskanovd@mail.ru

Ophthalmologist

Russian Federation, Saint Petersburg

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2. Fig. 1. Surgical technic: a – retinal detachment induction; b – 270° external peripheral retinotomy; c – subretinal macular scar elimination; d – pedicled RPE/choroid graft preparation; e – rotation of RPE/choroid graft in macular zone; f – fundus ophthalmoscopy at the end of surgery

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3. Fig. 3. Visual field dynamic after silicon oil removal: a – pre-op; b – 1 month; c – 6 months; d – 12 months; e – 18 months; f – 24 months. Blue zone — absolute scotoma; brown zone – relative scotoma

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4. Fig. 4. Fundus ophthalmoscopy dynamic after silicon oil removal: a – pre-op; b – 1 month; c – 6 months; d – 12 months; e – 18 months; f – 24 months

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5. Fig. 5. OCT dynamic after silicon oil removal: a – pre-op; b – 1 month; c – 6 months; d – 12 months; e – 18 months; f – 24 months

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6. Fig. 6. Indocian-green angiography dynamic after silicon oil removal: a – 1 month; b – 6 months; c – 12 months

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7. Fig. 2. Visual acuity dynamic

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Copyright (c) 2021 Sosnovskii S.V., Boiko E.V., Oskanov D.K.

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