Macular functionality after autologous transplantation of the retinal pigment epithelium in patients with neovascular age-related macular degeneration with scarring

BACKGROUND: The treatment options for neovascular age-related macular degeneration with subretinal fibrosis are extremely limited because of severe changes in the outer retinal layers. One of the promising treatment in such cases is transplantation of the autologous retinal pigment epithelium into the macula to restore its anatomical structure and ensure functioning of photoreceptors.

AIM: The study aimed to assess changes in light sensitivity and electric activity of the sensory retina in the area of the transplanted autologous flap of the retinal pigment epithelium in patients with subretinal fibrosis associated with neovascular age-related macular degeneration.

METHODS: The prospective study included 19 patients aged 67 to 87 years with neovascular age-related macular degeneration complicated by subretinal fibrosis who underwent autologous retinal pigment epithelium transplantation. Best corrected visual acuity was measured, light sensitivity at the fixation point, mean light sensitivity in the fovea and parafovea, fixation area, mean deviation, and pattern standard deviation were assessed using microperimetry, and latency and amplitude of P1 in R1–R4 (a 61-hexagon array) were assessed using multifocal electroretinography. The examinations were performed before, 3, 6, and 12 months after retinal pigment epithelium transplantation. The relationship between postoperative changes in best corrected visual acuity, light sensitivity, and electric activity was analyzed.

RESULTS: The following functional parameters significantly increased 12 months after retinal pigment epithelium transplantation: best corrected visual acuity increased from 0.05 (0.03; 0.08) to 0.09 (0.06; 0.1) (p = 0.009), light sensitivity at the fixation point increased from 2 (0; 19) to 26 (17; 28) dB (p = 0.004), mean light sensitivity in the fovea and parafovea also increased from 2.71 (0.38; 4.14) to 5.22 (3.98; 13.47) dB (p = 0.001); the fixation area decreased from 56.3 (28.04; 108.82)^o2 to 19.75 (11.19; 33.26)^o2 (p = 0.0003), mean deviation decreased from −24.33 (−26.45; −22.45) to −21.92 (−24.1; −19.32) dB (p = 0.004), whereas pattern standard deviation did not change significantly (p = 0.888). Electric activity parameters also changed during the postoperative period, but 1 year postoperatively, the P1 amplitude significantly increased only in R2 (from 0.12 (0.10; 0.17) to 0.14 (0.12; 0.24) μV (p = 0.033)), R3 (from 0.1 (0.07; 0.23) to 0.14 (0.11; 0.23) μV (p = 0.029)), and R4 (from 0.11 (0.05; 0.15) to 0.13 (0.11; 0.17) μV (p = 0.044)). The postoperative change in best corrected visual acuity correlates with the changes in light sensitivity at the fixation point (r = 0.48, p = 0.039), mean light sensitivity (r = 0.38, p = 0.043), and P1 amplitude in R1 (r = 0.42, p = 0.04).

CONCLUSION: Autologous retinal pigment epithelium transplantation in patients with neovascular age-related macular degeneration with scarring increases visual acuity and macular functionality. The increase in best corrected visual acuity correlates with the increase in light sensitivity and retinal electric activity over the transplanted flap of the retinal pigment epithelium.