title: Outcome of transplantation of autologous retinal pigment epithelium in age-related macular degeneration: a prospective trial.
abstract: OBJECTIVE
  To present the outcome of a consecutive series of patients who had foveal choroidal neovascularization (fCNV) in age-related macular degeneration (AMD) and were treated with subretinal surgery combined with simultaneous transplantation of autologous retinal pigment epithelial (RPE) cells.
  
  
  METHODS
  Patients with fCNV who were not eligible for laser or photodynamic therapy were included in the study. They underwent subretinal membrane excision with simultaneous transplantation of autologous RPE cells. Eyes with membrane excision alone served as the control. Tests included best corrected visual acuity for far and near with Early Treatment Diabetic Retinopathy Study (ETDRS) and Jaeger charts, multifocal (mf)ERG, central visual field analysis, optical coherence tomography (OCT), and angiography, before surgery, and 1 month and 3 months after treatment, and at 3-month intervals thereafter.
  
  
  RESULTS
  The results of final examinations of 53 eyes are presented. In 39 eyes, RPE transplantation was performed (group 1); 14 eyes had membrane excision alone (group 2). In group 1, visual acuity improved significantly, two or more lines in 21 (53.8%) patients; remained stable in 12 patients (30.8%); and decreased two or more lines in 6 patients (15.4%; P=0.0062). In group 2, the corresponding values were 21.1%, 57.8%, and 21.1% (P=0.5377 NS). Statistical analysis of results in the two groups showed a trend in favor of group 1 (P=0.9714). The difference in reading acuity was significant between the two groups (mean change in group 1: 1.85 +/- 0.42 vs. 0.43 +/- 0.47 in group 2; P=0.0001). mfERG response density changes were significantly different between groups 1 and 2 (P=0.0094). No significant decreases in central visual field defects were detected. OCT showed the postoperative median retinal thickness in the lesion area in group 1 to be higher (242.31 +/- 12.30 microm) than in group 2 (202.07 +/- 10.68 microm), showing a trend (P=0.0682).
  
  
  CONCLUSIONS
  Patients undergoing fCNV removal with autologous transplantation of RPE reached significantly better reading acuity and higher mfERG-response density than control subjects. The results provide evidence that autologous transplantation of RPE is a beneficial supplement to membrane excision alone in patients with fCNV in AMD and may be regarded as a reasonable treatment option.
authors.affiliation: Department of Ophthalmology, Rudolf Foundation Clinic, Vienna, Austria. susanne.binder@wienkav.at
authors.forename: Susanne
authors.initials: S
authors.lastname: Binder
authors.forename: Ilse
authors.initials: I
authors.lastname: Krebs
authors.forename: Ralf-Dieter
authors.initials: RD
authors.lastname: Hilgers
authors.forename: Ali
authors.initials: A
authors.lastname: Abri
authors.forename: Ulrike
authors.initials: U
authors.lastname: Stolba
authors.forename: Adele
authors.initials: A
authors.lastname: Assadoulina
authors.forename: Lukas
authors.initials: L
authors.lastname: Kellner
authors.forename: Boris V
authors.initials: BV
authors.lastname: Stanzel
authors.forename: Christian
authors.initials: C
authors.lastname: Jahn
authors.forename: Hans
authors.initials: H
authors.lastname: Feichtinger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017690:Cell Transplantation; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D004596:Electroretinography; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D008268:Macular Degeneration / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010857:Pigment Epithelium of Eye / Q000166:cytology / Q000637:transplantation*; D011446:Prospective Studies; D041623:Tomography, Optical Coherence; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014792:Visual Acuity; D014794:Visual Fields
chemical_list: D007208:Indocyanine Green