Translocation of iris pigment epithelium in patients with exudative age-related macular degeneration — long term results

Abstract

Purpose: To report the practicability and efficacy of autologous iris pigment epithelium (IPE) translocation in exudative age-related macular degeneration (ARMD) over 1 year. Methods: The consecutive interventional case series included 56 patients with exudative ARMD. During vitrectomy the submacular neovascular membrane (CNV) was removed and IPE cells, harvested from a peripheral iridectomy, were injected into the submacular space. Included were patients with subfoveal occult CNV (11 eyes), classic CNV (10 eyes), mixed CNV (17 eyes), CNV with a pigment epithelial detachment (13 eyes) or CNV with a hemorrhage (5 eyes). Outcome measures were visual acuity, foveal fixation, size of CNV and rate of recurrence based on fluorescence angiographic imaging. Results: All patients underwent successful surgical removal of the CNV with consecutive subretinal IPE injection.

Autologous translocation of the choroid and RPE in age-related macular degeneration: 1-year follow-up in 30 patients and recommendations for patient selection

“…There was a mean increase of 0.1 log MAR from 3 to 12 months. This demonstrates that in contrast to mere membrane extraction or IPE translocation, 13,20 sheet translocation achieves an overall stabilization of the preoperative level of VA. Improvement of VA is possible even later during the follow-up.…”

“…Earlier attempts of pigment cell translocation using cell suspensions could not find autofluorescence related to the transplants at all. 13,14 Autofluorescence may be greater in the periphery because the disc-lipofuscin load may be greater there, in line with the increased rod density. Furthermore, the photoreceptors around the fovea will be damaged by AMD and this might represent a re-establishment of disc turnover status quo.…”

“…8,9 We have recently reported on the functional results and complication profile in our first series. 10 Yet, any treatment has to be judged by its long-term benefits and despite of initial encouraging results with RPE and iris pigment epithelium (IPE) transplantation techniques, 11,12 long-term results demonstrated a preservation of foveal function only on a low level, but no improvement in VA. 13,14 Here, we assessed whether the initial results of patch translocation remain stable in the long-term follow-up.…”

Replacement of the RPE monolayer

“…IPE cells can be harvested from a simple surgical procedure, such as an iridectomy 30 and provide an autologous source of cells thus overcoming the problems associated with immune rejection and long-term immunosupression. In addition, the IPE cells may afford the advantage of being relatively healthier than peripheral RPE, which may to some extent be affected by the underlying disease.…”

“…Central fixation with stabilisation of vision has been documented in neovascular AMD and in some patients with traumatic RPE detachments, 30,32,35,36 but complications such as those seen in RPE transplantation, including, retinal detachment, PVR, macular pucker and CNV recurrence have been reported. 30,32,35 It is encouraging that recent follow up studies by Aisenbrey et al 37 have reported a stabilisation in visual acuity in 65% of patients who underwent autologous IPE transplantation after CNV removal and showed no signs of rejection or CNV recurrence.…”