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Proof of conceptTranslocation and Transplantation in AMD
The principle of surgical treatment in AMD is that of cell rescue. The concept of cell rescue and subsequent restoration of vision has been demonstrated following trials of two surgical techniques. The first was macular translocation surgery (MTS) and the second, autologous block transplantation.
Both of these surgical techniques have shown that replacing the diseased RPE and choroidal cells restores vision thus providing proof of concept of this approach. We learnt that patients who had MTS within a 6-10 week window of sudden visual loss are more likely to benefit from surgery than those who presented later. Furthermore, patients who were able to target their fixation on a bright stimulus do better as they may have more viable photoreceptor cells to be rescued. Thus replacing diseased support cells can restore visual function, with some patients reading and re-gaining their driver’s licence. In contrast, in patients who only had removal of choroidal neovascular membrane without replacement of underlying RPE and choroid had very poor outcomes. These trials and the findings of visual improvement act as the bases for the development of RPE transplantation as a viable option for treatment in AMD.