Advantages:

Choroidal neovascularization in age related macular degeneration (AMD), non-responder to standard care, might be treated with autologous transplantation of retinal pigment epithelium and choroid (PATCH). The purpose was to define prognostic criteria for this surgery, to improve the result.

Methods:

Thirty eyes underwent PATCH surgery. Follow-up was 36 months. Patients received ETDRS, OCT scan and fluorescein and indocyanine green angiography (Heidelberg). OCT evaluated the pre-operative integrity of each foveal layer. Based on last ETDRS, patients were divided into 2 groups: “improved” (≥1 line) and “not-improved” (stable or worsened). The correlation between the 2 groups and imaging was studied. ICGA and OCT determined the time of revascularisation of the PATCH and the features of the site of harvesting (SoH). Patients were divided into: “revascuarized” (revascularization 30 days). The correlation between the 2 groups and imaging was studied.

Results:

Mean LogMAR BCVA: 1.7 pre-op. Mean LogMAR BCVA:1.4 one year post-op  (T test p=0.006). The majority of the patches were revascularized by two weeks postoperatively. The CFT and the thickness of the patch normalized by 1 month. The IS-OS segment layer became visible in one month. No correlation with harvesting site location and distance from the fovea. The best functional outcome related to: 1. Preserved neuroretinal macular function; 2. Functioning RPE choroid graft Eight percent of the grafts never revascularized.

Conclusions:

PATCH surgery may lead to significant improvement in vision. Foveal integrity examined with OCT represents the most significant prognostic criterion.