Adult retinal pigment epithelial transplantation in exudative age-related macular degeneration.
OBJECTIVE
To improve visual function by retinal pigment epithelial (RPE) cell transplantation and systemic immunosuppression at the time of surgical removal of subfoveal choroidal neovascularization in exudative age-related macular degeneration (AMD).


METHODS
An interventional case series of RPE transplantation in exudative AMD.


METHODS
Twelve patients (one eye only) underwent subfoveal membranectomy with transplantation of a sheet of adult human allogeneic RPE cells at a single institution and were followed for one year. Eligibility criteria included age >60, best-corrected acuity < or =20/63 and subfoveal neovascularization < or =9 disk areas on preoperative fluorescein angiography. All patients were started on triple immunosuppression postoperatively. The primary outcome measure was best-corrected vision, with contrast sensitivity and reading speed as secondary outcome measures.


RESULTS
The best-corrected visual acuity (P = .085), contrast sensitivity (P = .204), and the reading speed (P = .077) did not change significantly at one year compared with preoperative values. Transplants showed no signs of rejection in patients who were able to continue the immunosuppressants for six months. Postoperative surgical complications included cataract progression requiring surgery (three of eight phakic eyes), retinal detachment (three eyes), intraoperative retinal breaks (two eyes), and macular pucker (two eyes). None of the patients developed cystoid macular edema on postoperative fluorescein angiography or postoperative inflammation.


CONCLUSIONS
A sheet of adult human allogeneic RPE can be transplanted into the subretinal space in AMD patients at the time of subfoveal membranectomy. Systemic immune suppression appeared to prevent rejection of the transplanted tissue, but did not lead to an improvement in visual function.
Tezel
Tongalp H
TH
Department of Ophthalmology & Visual Sciences, Kentucky Lions Eye Center, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Del Priore
Lucian V
LV
Berger
Adam S
AS
Kaplan
Henry J
HJ
D000368:Aged; D000369:Aged, 80 and over; D001379:Azathioprine / Q000627:therapeutic use; D017690:Cell Transplantation; D020256:Choroidal Neovascularization / Q000188:drug therapy / Q000601:surgery; D003131:Combined Modality Therapy; D015350:Contrast Sensitivity; D016572:Cyclosporine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005122:Exudates and Transudates; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008268:Macular Degeneration / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D010857:Pigment Epithelium of Eye / Q000637:transplantation*; D011446:Prospective Studies; D014184:Transplantation, Homologous; D014792:Visual Acuity
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D001379:Azathioprine