Autologous retinal pigment epithelium-choroid sheet transplantation in age related macular degeneration: morphological and functional results

Abstract

Objective: To evaluate the outcome of autologous retinal pigment epithelium (RPE)-choroid sheet transplantation after removal of a subfoveal choroidal neovascularisation (CNV) in patients with age related macular degeneration (AMD). Methods: RPE-choroid sheet transplantation was performed in 10 consecutive patients with exudative AMD (n = 9) or geographic atrophy (n = 1). After CNV extraction, an autologous RPE-choroid patch was translocated from the midperiphery under the macula. Follow-up was between 6 and 12 months. Visual acuity testing and microperimetry (Nidek-MP1) as well as autofluorescence, fluorescein and indocyanine green (ICG) angiography were performed and the data were analysed retrospectively. Results: Visual acuity (logarithm of minimum angel of resolution) before operation ranged from 0.7 to 1.8 (mean 1.37) and after operation from 0.4 to 1.6 (mean 1.24). Visual acuity after operation improved in seven patients (by a mean of 0.26), remained stable in one patient and decreased in two patients. Microperimetry showed light sensitivity and fixation on the sheet in five cases. ICG angiography demonstrated perfusion through the RPE-choroid graft in nine patients. Postoperative complications included retinal detachment (n = 1) and epiretinal membrane formation (n = 2). The patient with geographic atrophy developed a CNV after surgery. Conclusions: Autologous RPE-choroid sheet transplantation is feasible and a comparatively safe procedure. Microperimetry showed fixation and light perception over the graft with a moderate increase in mean visual acuity.

Long term visual and microperimetry outcomes following autologous retinal pigment epithelium choroid graft for neovascular age-related macular degeneration

“…Using various techniques to study fixation, previous studies have also shown 40 to 74% of eyes achieved fixation over the graft. [34][35][36][37][38][39] Similar to that reported by Maaijwee et al, we also found that fixation stability may worsen or improve during follow-up. 40 The reason for worsening of fixation stability may be related to delayed cystic change or atrophy whereas improvement in stability may be related to adaptation to eccentric fixation and viewing.…”

Subretinal implantation of a monolayer of human embryonic stem cell-derived retinal pigment epithelium: a feasibility and safety study in Yucatán minipigs

“…No such complications were observed in our study. Early and late postoperative complications in human subjects, however, have included intraocular hemorrhage, serous macular detachment, epiretinal membrane formation, the development of proliferative vitreoretinopathy, or the induction of choroidal neovascularization in a patient who previously had dAMD [23,25].…”

Improving RPE adhesion to Bruch's membrane

“…One of the techniques used in human patients has been removal of CNVs from the abnormally neovascularized Brush's membrane, followed by autologous transplantation of RPE cells subretinally to allow repopulation of the Bruch's membrane. 10,11 Although this technique is effective in removing the CNVs, an undesirable consequence is the stripping of RPE cells and removal of the basement membrane of Bruch's exposing the deeper collagenous layers. However, functional recovery post-RPE transplantation has been shown to be limited because most of the RPE cells die shortly after transplantation, and they do not migrate out from the site of implantation.…”