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Human retinal transplantation has followed many years of experimental research showing that transplanted retinal pigment epithelial (RPE) cells have the potential to rescue photoreceptors (PR).1–3 Histopathological studies have demonstrated integration of cultured cell suspensions in the subretinal space in animals, and blind rats showed regain of functions after RPE transplantation.4 However, it was also demonstrated from several groups that freshly harvested or cultured RPE suspensions may fail to survive or function on aged or damaged Bruch membrane (BM).5–7 An uneven distribution of RPE cells caused the formation of multilayers of RPE alternating with bare areas of basal lamina.8 Furthermore, in a hostile environment, the subfoveally delivered cells have less chance of survival. The inability to grow well on a defective or diseased basal lamina is considered a major problem as to why transplanted RPE cells fail to function for a prolonged period and cannot significantly restore vision in human eyes.9 Today, transplantation of a polarised RPE monolayer as a sheet seems to be more promising.
In human eyes with advanced age-related macular degeneration (AMD), a logical consequence is to translocate an autologous RPE BM choroid patch, taken from a more distant location of the same eye.10 11 While some cases have shown good functional results, and visual acuities up to 20/40 can be achieved in single cases with this technique, the overall visual gain reported is about one line, and complications such as proliferative vitreoretinopathy are observed …
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