Background: We investigate the safety and feasibility of large retinal pigmentary epithelium (RPE)-Choroid-free graft after surgical drainage of massive sub-macular hemorrhage (SMH) due to age-related macular degeneration (ARMD).
Methods: Four previously untreated patients (three females and one male) underwent to three port pars plana vitrectomy, induction of retinal detachment and peripheral temporal 180 degrees retinotomy. The retina was then folded nasally, to allow access for removal of sub-macular Hg and CNV complex. A full-thickness-large autologous Chorio-RPE patch was grafted. Silicone oil was used as endotemponade for approximately 12 weeks. After removal of silicone oil, the patients were followed-up for 6 months.
Results: SMH was completely removed in all cases. It was possible to graft a large RPE patch safely that is sufficiently large to cover the entire defect of macular RPE. At last follow-up, improvement in visual acuity (from 3 +/- 0.9 to 55 +/- 9 ETDRS letters) and recovery of central fixation was observed in all patients.
Conclusions: Our surgical technique for large elevated SMH seems to be feasible and efficacious approach to harvest and relocate large RPE patch and to save limited vision in selected patients.