Preliminary Study on Electrophysiological Changes After Cellular Autograft in Age-Related Macular Degeneration

Abstract

Evolving atrophic macular degeneration represents at least 80% of all macular degenerations and is currently without a standardized care. Autologous fat transplantation efficacy was demonstrated by several studies, as these cells are able to produce growth factors. The aim of the work was to demonstrate possible therapeutic effect of the joined suprachoroidal graft of adipocytes, adipose-derived stem cells (ADSCs) in stromal vascular fractions (SVFs) of adipose tissue, and platelet-rich plasma (PRP).Twelve eyes in 12 dry age-related macular degeneration (AMD) patients, aged 71.25 (SD ± 6.8) between 62 and 80 years, were analyzed. A complete ocular evaluation was performed using best corrected visual acuity (BCVA), retinographic analysis, spectral-domain optical coherence tomography, microperimetry, computerized visual field, and standard electroretinogram (ERG). Each eye received a cell in graft between choroid and sclera of mature fat cells and ADSCs in SVF enriched with PRP by means of the variant second Limoli (Limoli retinal restoration technique [LRRT]). In order to test if the differences pre- and post-treatment were significant, the Wilcoxon signed-rank test has been performed.Adverse effects were not reported in the patients. After surgery with LRRT, the most significant increase in the ERG values was recorded by scotopic rod-ERG (answer coming from the rods), from 41.26 to 60.83 μV with an average increase of 47.44% highly significant (P < 0.05). Moderately significant was the one recorded by scotopic maximal ERG (answer coming from the rods and cones), from 112.22 to 129.68 μV with an average increase of 15.56% (P < 0.1).Cell-mediated therapy based on growth factors used appears interesting because it can improve the retinal functionality responses in the short term. The ERG could, therefore, be used to monitor the effect of cell-mediated regenerative therapies.

Cell surgery and growth factors in dry age-related macular degeneration: visual prognosis and morphological study

“…Residual retinal trophism in dry AMD, value with RTA, may represent a prognostic criterion for the indication of cellular autograft with LRRT, since better outcomes are found increasingly in group B. We already saw the positive action on retinal electrical activity in our previous study, and the current study has shown that scotopic ERG, BCVA and sensitivity detected by MY appear to be more intense in thicker retinas (Table 2, Figure 2, 3, and 4) [4, 19]. On the contrary, natural evolution shows inevitable visual impairment, according to clinical events [1–3].…”

“…each eye of our subjects received cellular autograft according to LRRT, after the harvest of SVF with ADSCs and Platelet Rich Plasma, an innovation of Pelaez-Meduri's intervention [4, 12, 13, 19]. They used a transplantation of autologous fat in the subscleral space, obtaining relevant but transient results [5, 19].…”

“…They used a transplantation of autologous fat in the subscleral space, obtaining relevant but transient results [5, 19]. The goals of LRRT, that is the grafting of the suprachoroidal adipose pedicle, of ADSCs in SVF and intrapeduncolar PRP were to:…”

“…Moreover, we observed that cone-rod ERG and rod ERG present a highly significant correlation with RTA, while cone ERG does not, since the main functional expression of fovea appears to be compromised also with still regular macular volumes in dry AMD, at least in the initial stages (Figure 2) [4, 5, 19]. Residual retinal trophism in dry AMD, value with RTA, may represent a prognostic criterion for the indication of cellular autograft with LRRT, since better outcomes are found increasingly in group B.…”

“…Cellular autograft efficacy in dry AMD was demonstrated by Limoli et al in preliminary works [4, 19–21]. Indeed, to curb the worsening of retinal dry AMD, we considered employing two important elements:…”