Autologous retinal pigment epithelium and choroid translocation in patients with exudative age-related macular degeneration: short-term follow-up

Meurs, Jan C. van; Biesen, Pieter R van den

doi:10.1016/s0002-9394(03)00384-2

Cited by 150 publications

(106 citation statements)

References 25 publications

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“…This approach was refined in Moorfield's Eye Hospital [19,32]. To minimize trauma to the macular area, we pioneered a technique to cut out the graft from the midperiphery [22,24]. The feasibility of this technique has recently been confirmed in other pilot studies [15,20].…”

Section: Introductionmentioning

confidence: 99%

Retinal pigment epithelium and choroid translocation in patients with exudative age-related macular degeneration: long-term results

Maaijwee

Heimann

Missotten

et al. 2007

Graefes Arch Clin Exp Ophthalmol

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Background To study the results of the translocation of a free autologous retinal pigment epithelium (RPE)-choroid graft after removal of a subfoveal choroidal neovascular membrane in patients with exudative age-related macular degeneration (AMD), and to determine whether preoperative variables may predict visual outcome at 1 year after surgery. Methods Prospective interventional case series of 84 eyes of 83 consecutive eligible patients with exudative AMD with a minimal follow-up of 1 year after surgery. Of this group, 45, 24 and 11 patients reached a follow-up of respectively 2, 3 and 4 years. Pre-and postoperative evaluation included ETDRS visual acuity (VA), fixation testing and color fundus photography. Preoperative fluorescein angiograms were assessed by masked readers for lesion size, size of hemorrhage and lesion composition according to the MPS criteria. The relationship between lesion composition adjusted for preoperative delay and VA, lesion size, percentage of blood, and visual outcome at 1 year after surgery was analyzed. Results The mean VA (logMAR) improved slightly at 1 and 2 years (0.89, Δ=−0.06), 3 years (0.79, Δ=−0.16) and 4 years (0.74, Δ=−0.21) after surgery. Five patients had a preoperative VA better than 20/80, compared to 19 out of 84, six out of 45, four out of 24 and two out of 11 after 1, 2, 3 and 4 years respectively. Fixation was located on the graft in 62 patients (74%) up to the last examination. Predominantly classic and occult lesions had a significant better prognosis than minimally classic or hemorrhagic (≥50% blood) lesions. Retinal detachment occurred in seven patients; two caused by rhegmatogenous detachment and five caused by proliferative vitreoretinopathy. In 11 eyes, a recurrent or persisting neovascular membrane was observed. Conclusion An autologous free RPE-choroid graft may stabilize or improve vision in patients with exudative AMD up to 4 years after surgery.

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Section: Introductionmentioning

confidence: 99%

Retinal pigment epithelium and choroid translocation in patients with exudative age-related macular degeneration: long-term results

Maaijwee

Heimann

Missotten

et al. 2007

Graefes Arch Clin Exp Ophthalmol

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“…26 Four of the six patients showed improvement in visual acuity but this technique still carries with it a significant risk of intraocular haemorrhage, retinal detachment, and PVR. Van Meurs' group recently published the long-term outcomes of 133 patients who underwent CNV excision followed by autologous RPEChoroid grafting.…”

Section: Autologous Rpe-choroid Patch Graftmentioning

confidence: 87%

“…This technique was subsequently adapted for RPE collecting in pigs 37 and rabbits. 38 However, several investigators have utilised an internal approach in humans, consisting of pars plana vitrectomy, surgical excision of subfoveal CNV, followed by translocation of dissociated RPE cells 28 or an RPE/BrM/choroid graft, [24][25][26] either free or pedicled. The external approach is preferable in animal studies, especially in rodents, where the globe is small, the lens is large, and there is no true vitreous cavity to operate within (see Figure 2).…”

Section: Surgical Approach: External Vs Internalmentioning

confidence: 99%

Retinal pigment epithelium transplantation: concepts, challenges, and future prospects

Alexander

Thomson

Luff

et al. 2015

Eye

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The retinal pigment epithelium (RPE) is a single layer of cells that supports the light-sensitive photoreceptor cells that are essential for retinal function. Age-related macular degeneration (AMD) is a leading cause of visual impairment, and the primary pathogenic mechanism is thought to arise in the RPE layer. RPE cell structure and function are well understood, the cells are readily sustainable in laboratory culture and, unlike other cell types within the retina, RPE cells do not require synaptic connections to perform their role. These factors, together with the relative ease of outer retinal imaging, make RPE cells an attractive target for cell transplantation compared with other cell types in the retina or central nervous system. Seminal experiments in rats with an inherited RPE dystrophy have demonstrated that RPE transplantation can prevent photoreceptor loss and maintain visual function. This review provides an update on the progress made so far on RPE transplantation in human eyes, outlines potential sources of donor cells, and describes the technical and surgical challenges faced by the transplanting surgeon. Recent advances in the understanding of pluripotent stem cells, combined with novel surgical instrumentation, hold considerable promise, and support the concept of RPE transplantation as a regenerative strategy in AMD.

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“…Case selection procedures are being developed using algorithma to assess suitability for macular translocation, which may increase surgical successes. 9 However, Van Meurs et al and Stanga et al 10,11 have shown some functional results following patch graft transplant procedures at 1 year and over 2 years followup respectively with improvement in visual function, fixation of the graft using ocular coherence tomography and its vascularisation confirmed by fluorescein and indocyanide green angiography. These procedures used autologous peripheral full-thickness grafts, which were composed of neurosenory retina, RPE, Bruch's membrane, choriocapillaris and choroid and were usually harvested from the midperiphery prior to translocation to the macular following CNV removal.…”

Section: Introductionmentioning

confidence: 99%

Replacement of the RPE monolayer

Sheridan

Mason

Pattwell

et al. 2009

Eye

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There are numerous scenarios in which replacing the diseased RPE monolayer is an attractive but as yet unrealised goal. The proof of concept that vision can be improved by placing a healthy neuroretina onto a different, healthy, underlying RPE layer is demonstrated in patch graft transplantations. The surgical procedure to relocate the neuroretina is both complex and is hampered by postoperative complications and as such newer replacement procedures are also being investigated including stem cell replacement therapies. Past studies have largely focused on using cell suspensions and have had disappointing outcomes largely due to the lack of control over cellular differentiation, incomplete attachment onto Bruch's membrane and subsequent integration into the existing RPE monolayer. The choice of which cells to transplant is still under investigation and is complicated by factors such as the ease of collection of an adequate sample, rejection following implantation, the age of the cells and ethical issues. In all these situations, however, understanding the mechanisms of cellular differentiation are likely to be prerequisite to future successes. The current research into replacing the RPE monolayer is briefly discussed with reference to our experiences comparing IPE and RPE cells in an in vitro environment.

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Autologous retinal pigment epithelium and choroid translocation in patients with exudative age-related macular degeneration: short-term follow-up

Cited by 150 publications

References 25 publications

Retinal pigment epithelium and choroid translocation in patients with exudative age-related macular degeneration: long-term results

Retinal pigment epithelium and choroid translocation in patients with exudative age-related macular degeneration: long-term results

Retinal pigment epithelium transplantation: concepts, challenges, and future prospects

Replacement of the RPE monolayer

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