Reduction of iatrogenic RPE lesions in AMD patients: evidence for wound healing?

Purpose Our purpose was to study retinal pigment epithelium (RPE) wound healing in patients with age-related macular degeneration (AMD). Patients and methods Abrasive debridement of nasal RPE was performed with a metal cannula during pars plana vitrectomy for foveal choroidal neovascularization (CNV) membrane excision combined with simultaneous autologous RPE transplantation. Fundus autofluorescence, fluorescein angiography images, and red-free pictures were taken initially within 1–2 weeks postoperatively, subsequently in 2-week intervals until 3 months, monthly until 6 months, and every 3 months thereafter. The borders of these lesions were measured; areas were calculated and compared using ArchiCad Software. Fourteen eyes of 14 patients suffering from AMD were included (nine women and four men, mean age 75.6 years ±6.6 years). Results Six of 14 (42.9 %) patients showed a reduction of the RPE debrided area. The size of these lesions reduced 5.6–20% within 2 postoperative months compared with their size at first examination (from a mean of 13.7 mm2 ± 7.2 at baseline to a mean of 12.8 mm2 ± 6.7 at 2 months postoperatively). No further reduction of the lesions was seen after the 2 months. In eight cases, borders of the RPE debrided areas stayed stable during observation time. Conclusions Wound healing of abrasively debrided RPE monolayer defects in patients with AMD occurs to a certain extent in nearly half of the cases. This process seems to stop after 2 months. Presented in part at the annual meeting of the Association for Research in Vision and Ophthalmology, Fort Lauderdale, FL, USA, 25–29 April 2004. Supported by unrestricted research grant from the L. Boltzmann Institute to SB.