Original article
Transplantation of autologous retinal pigment epithelium in eyes with foveal neovascularization resulting from age-related macular degeneration: a pilot study

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Abstract

PURPOSE: To describe the indications, surgical technique, and clinical results of 14 eyes in 13 patients with age-related macular degeneration and foveal choroidal neovascularization, in which subretinal surgery was combined with simultaneous transplantation of autologous retinal pigment epithelial cells.

METHODS: Between March 1999 and February 2000, in a prospective study, 14 eyes (13 patients) with age-related macular degeneration underwent subretinal surgery because of foveal choroidal neovascularization with simultaneous transplantation of retinal pigment epithelium harvested from the nasal subretinal area of the same eye. Preoperatively, 1 month postoperatively, 3 months postoperatively and at 3-month intervals thereafter, examinations were performed including best-corrected visual acuity, visual field, biomicroscopy of anterior and posterior segment, tonometry, fluorescein and indocyanine angiographies, autofluorescence, scotometry, and fixation tests.

RESULTS: Postoperatively, after median observation of 17 months (range, 12 to 24 months) best-corrected visual acuity was improved 2 or more lines in eight eyes (57.1%), remained the same (± 1 line) in five eyes (35%), and decreased by more than 2 lines in one eye (7.1%). Pairwise t test showed significant improvement after 1 month (P = .0031, P = .0062) as well as 1 year (P = .0066, P = .0105). Satisfactory reading vision between Jaeger 1 and 4 was achieved in three eyes (21.2%). No significant intraoperative or postoperative complications occurred in any eye. No recurrence of choroidal neovascularization was observed during the observation period.

CONCLUSIONS: In eyes with age-related macular degeneration and foveal choroidal neovascularization, autotransplantation of retinal pigment epithelium was performed in addition to conventional removal of the choroidal neovascularization without significant intraoperative or postoperative complications. Visual acuity improvement of 2 or more lines in 57% of the eyes was achieved. No recurrent choroidal neovascularization formation was observed during the observation period. The results of this pilot study suggest that autologous transplantation of retinal pigment epithelium combined with submacular surgery might be a reasonable treatment option for patients with foveal choroidal neovascularization secondary to age-related macular degeneration.

Section snippets

Patients and methods

Fourteen consecutive eyes of 13 patients were included in this prospective pilot study. Eyes underwent surgery within a 1-year period (March 1999 to February 2000).

The study was approved by the institutional review board of the Rudolf Foundation Clinic, and subjects signed informed consent forms that indicated that the procedure was a novel experimental approach and an alternative to conventional membrane extraction surgery and laser photocoagulation. This study was a consecutive interventional

Results

The median observation time was 17 months (range, 12 to 24 months). The age of the patients ranged from 48 to 82 years (median, 73.5). Five were male, and eight were female.

Preoperatively, the best-corrected visual acuity ranged from 20/50 to finger counting (median, 20/590). Twelve-month follow-up results showed that best-corrected visual acuity was improved 2 or more lines in eight eyes (57.1%), remained the same (± 1 line) in five eyes (35%), and decreased by more than 2 lines in one eye

Discussion

Our hypothesis, that retinal pigment epithelium transplantation could be an effective therapy, was based on the following facts: In membranes with rapid growth, the retinal pigment epithelium is only partly damaged and partially hyperactive.30 Bruch membrane is locally fragmented but not completely missing.31 The nasal retinal quadrant contains relatively more retinal pigment epithelium cells than the other three quadrants32 and is much less involved in the disease. The addition of retinal

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