Transplantation of HLA-typed RPE in age-related macular degeneration — results after 6 months follow-up
Purpose: The retinal pigment epithelium (RPE) has been assumed to be causally involved in the pathogenesis of age-related macular degeneration (ARMD). The purpose of this prospective study was to determine the feasibility, safety and visual outcome of transplanting HLA-typed RPE cells in a series of patients suffering from ARMD with geographic atrophy of the RPE.
Patients and methods: RPE cells were isolated from donor eyes and cultured in a special medium. One part of the culture was subcultured for HLA-typing, the other part cryopreserved in a cell bank. In 9 eyes of 9 patients suffering from bilateral ARMD with geographic atrophy and visual deterioration, HLA-matched RPE cells were transplanted into the subretinal space. Patients underwent postoperative immunosuppressive therapy for six months.
Results: Throughout the follow-up of 6 months, no evidence of inflammation, infection or rejection of the graft was noted in any eye. There were no major retinal complications. In one treated eye, a retinal edema could be detected by fluorescein angiography and optical coherence tomography (OCT) that was due to the development of choroidal neovascularization (CNV). The vision slightly increased in four treated eyes, it remained stable in three treated eyes and declined in two treated eyes, whereas in none of the fellow eyes vision increased, remained unchanged in five eyes and decreased in four eyes.
Conclusion: The transplantation of adult human RPE cells in the subretinal space proved to be a safe surgical procedure. The use of HLA-matched RPE cells and postoperative immunosuppression seem to reduce the risk of graft rejection. The preliminary results of this study are encouraging with regard to the aim of RPE transplantation to arrest or delay the progression of the damage to the retina caused by geographic atrophy of the RPE.
KeywordsOptical Coherence Tomography Retinal Pigment Epithelium Subretinal Space Geographic Atrophy Retinal Pigment Epithelium Atrophy
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