Retinal Pigment Epithelium and Choroid Transplantation

This chapter discusses the surgical approach of retinal pigment epithelium (RPE)-choroidal patch transplantation for advanced age-related macular degeneration. The rationale behind this technique is the restoration of a healthy choriocapillaris-RPE complex to preserve photoreceptor function mainly in neovascular maculopathies that primarily impact the choroid and RPE. This surgical intervention is recommended before irreversible retinal damage occurs, particularly when preoperative visual function is still present, and the outer retina remains recognizable on optical coherence tomography scans. The chapter discusses best indications for surgery, contraindications, and the intricate surgical technique involved in RPE-choroidal patch transplantation. It outlines step-by-step details of the surgical procedure, addressing anesthesia, trocar placement, vitrectomy, induction of retinal detachment, choroidal neovascular membrane removal, choroidal patch preparation, and transplant. The chapter concludes by outlining the prognosis and the potential complications associated with the surgery.