Wall of Fame

Choroidal transplant for AMD subfoveal macular neovascularization

Congratulations to Dr. Barbara Parolini and Veronika Matello for submitting the January 2022 Case of the Month! This patient is a teacher who suffered from a wet AMD submacular hemorrhage. Despite six anti-VEGF injections, vision dropped to 20/200. She was 58 years old and unable to read. After a long discussion regarding the pros vs cons of surgery, she underwent autologous choroidal transplantation in 2013. The surgical procedure included 1) Complete pars plana vitrectomy, 2) Creation of a temporal retinal detachment, 3) Peripheral 200 degree retinotomy, 4) Macular neovascularization (MNV) removal, 5) Feeder vessel endodiathermy, 6) Designing the peripheral choroidal patch with endodiathermy, 7) Cutting and isolation of a full thickness autologous RPE and choroid transplant (under perfluorocarbon liquid, PFCL), 8) Translocation of the patch under the fovea (under PFCL), 9) Transfer of PFCL from under to over the retina with retinal reattachment, 10) Peripheral laser and 11) PVCL exchange for 1000cs silicone oil. Eight years later, Clarus 500 widefield photography shows the intact submacular choroidal autograft and the white area of bare sclera in the temporal quadrant which was the harvesting site of the autograft (image 1). Canon Xephilio S1 widefield OCT shows fairly normal retina overlying the graft. Xephilio A1 angioOCT shows the intact choroidal graft vessels arranged in a different direction compared to the native surrounding choroidal vasculature (image 2). When last examined near vision was 20/30. She recently developed a MNV in the contralateral eye which is being treated with anti-VEGF injections.