Autologous Transplantation of Simple Retinal Pigment Epithelium Sheet for Massive Submacular Hemorrhage Associated With Pigment Epithelium Detachment

PURPOSE. To evaluate the long-term outcome of autologous simple RPE sheet transplantation in patients with simultaneous massive submacular hemorrhage and pigment epithelium detachment (PED). METHODS. Fourteen patients with 10 occult AMD eyes and 4 PCV eyes underwent a surgical procedure including a 180 degrees peripheral temporal retinotomy, choroidal neovascular membrane (CNVM) excision, and transplantation of an autologous simple RPE sheet developed from the PED region outside the CNVM lesion. Best-corrected visual acuity, multifocal ERG, and microperimetry were recorded to evaluate macular function. Optical coherence tomography, fundus fluorescein angiography, and an RPE autofluorescence test were performed to observe the status of the transplanted simple RPE sheet. RESULTS. Mean follow-up duration was 24 +/- 6 months. Mean ETDRS score increased from 14.0 +/- 23.4 preoperatively to 31.+/- 6 23.8 at 18 months postoperatively (P < 0.05). Of 14 eyes, 5 (36%) presented with central fixation postoperatively, whereas only 3 (21%) eyes presented with central fixation preoperatively. Ten grafts (71%) showed normal RPE color. Postoperative complications included one (7%) retinal detachment due to proliferative vitreoretinopathy and one (7%) delayed recurrent submacular hemorrhage. CONCLUSIONS. Transplantation of an autologous simple RPE sheet for eyes with massive submacular hemorrhage associated with PED was achieved with a simplified surgical procedure, resulting in increased postoperative visual acuity.