RPE and Choroid Translocation in Anti-VEGF-Non-Responder

Until present it is difficult to indentify an Anti-VEGF Non-Responder early enough for submacular surgery to be still worthwhile. In this case (typically) surgery was considered not before VA had dropped to 0,1. There was an absolute scotoma temporal to the central fixation (microperimetry). Otherwise the surgical technique is identical to the approach for exsudative AMD before the introduction of VEGF-Blockers:

• Vitrectomy
• Posterior vitreous separation (if not yet present)
• 360 degree laser cerclage
• Laser demarcation of excision site (Retina choroid RPE) in the inferior periphery.
• Submacular BSS injection to create working space under the retina
• Retinotomy in the temporal horizontal raphe
• CNV extraction with angulated forceps
• Eventually removal of fresh hemorrhage
• Excision of the transplant
• Insertion under the macula through the retinotomy
• Postioning with spatula under the pressure of liquid perfluorocarbon
• PFCL Silicone (usually heavy silicone) exchange.