Transplantation of autologous retinal pigment epithelium in eyes with foveal neovascularization resulting from age-related macular degeneration: a pilot study

Binder, Susanne; Stolba, Ulrike; Krebs, Ilse; Kellner, Lukas; Jahn, Christian; Feichtinger, Hans; Povelka, Margit; Frohner, Ursula; Kruger, Andreas; Hilgers, Ralf-Dieter; Krugluger, Walter

« Previous Next »American Journal of Ophthalmology
Volume 133, Issue 2 , Pages 215-225, February 2002

Transplantation of autologous retinal pigment epithelium in eyes with foveal neovascularization resulting from age-related macular degeneration: a pilot study

Susanne Binder, MD
- Reprint requests to Susanne Binder, MD, Department of Ophthalmology, The Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Rudolf Foundation Clinic, Juchgasse 25, A 1030 Vienna, Austria; fax: 0043-1-71165/4609
- Department of Ophthalmology, The Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Rudolf Foundation Clinic (S.B., U.S., I.K., L.K., C.J., U.F.), Vienna, Austria; Institute of Pathology and Bacteriology, Rudolf Foundation Clinic (H.F.), Vienna, Austria; Institute for Histology and Embryology, Department of Cellbiology and Ultrastructioral Research, University Clinic (M.P.), Vienna, Austria; University Eye Clinic Vienna, AKH, Währinger Gürtel 18-20 (A.K.), Vienna, Austria; Institute for Biometrie, Rheinisch-Westfälische Technische Hochschule Aachen (R.-D.H.), Germany; and Institute of Clinical Chemistry, Rudolf Foundation Clinic (W.K.), Vienna, Austria
Ulrike Stolba, MD
- Department of Ophthalmology, The Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Rudolf Foundation Clinic (S.B., U.S., I.K., L.K., C.J., U.F.), Vienna, Austria; Institute of Pathology and Bacteriology, Rudolf Foundation Clinic (H.F.), Vienna, Austria; Institute for Histology and Embryology, Department of Cellbiology and Ultrastructioral Research, University Clinic (M.P.), Vienna, Austria; University Eye Clinic Vienna, AKH, Währinger Gürtel 18-20 (A.K.), Vienna, Austria; Institute for Biometrie, Rheinisch-Westfälische Technische Hochschule Aachen (R.-D.H.), Germany; and Institute of Clinical Chemistry, Rudolf Foundation Clinic (W.K.), Vienna, Austria
Ilse Krebs, MD
- Department of Ophthalmology, The Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Rudolf Foundation Clinic (S.B., U.S., I.K., L.K., C.J., U.F.), Vienna, Austria; Institute of Pathology and Bacteriology, Rudolf Foundation Clinic (H.F.), Vienna, Austria; Institute for Histology and Embryology, Department of Cellbiology and Ultrastructioral Research, University Clinic (M.P.), Vienna, Austria; University Eye Clinic Vienna, AKH, Währinger Gürtel 18-20 (A.K.), Vienna, Austria; Institute for Biometrie, Rheinisch-Westfälische Technische Hochschule Aachen (R.-D.H.), Germany; and Institute of Clinical Chemistry, Rudolf Foundation Clinic (W.K.), Vienna, Austria
Lukas Kellner, MD
- Department of Ophthalmology, The Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Rudolf Foundation Clinic (S.B., U.S., I.K., L.K., C.J., U.F.), Vienna, Austria; Institute of Pathology and Bacteriology, Rudolf Foundation Clinic (H.F.), Vienna, Austria; Institute for Histology and Embryology, Department of Cellbiology and Ultrastructioral Research, University Clinic (M.P.), Vienna, Austria; University Eye Clinic Vienna, AKH, Währinger Gürtel 18-20 (A.K.), Vienna, Austria; Institute for Biometrie, Rheinisch-Westfälische Technische Hochschule Aachen (R.-D.H.), Germany; and Institute of Clinical Chemistry, Rudolf Foundation Clinic (W.K.), Vienna, Austria
Christian Jahn, MD
- Department of Ophthalmology, The Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Rudolf Foundation Clinic (S.B., U.S., I.K., L.K., C.J., U.F.), Vienna, Austria; Institute of Pathology and Bacteriology, Rudolf Foundation Clinic (H.F.), Vienna, Austria; Institute for Histology and Embryology, Department of Cellbiology and Ultrastructioral Research, University Clinic (M.P.), Vienna, Austria; University Eye Clinic Vienna, AKH, Währinger Gürtel 18-20 (A.K.), Vienna, Austria; Institute for Biometrie, Rheinisch-Westfälische Technische Hochschule Aachen (R.-D.H.), Germany; and Institute of Clinical Chemistry, Rudolf Foundation Clinic (W.K.), Vienna, Austria
Hans Feichtinger, MD
- Department of Ophthalmology, The Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Rudolf Foundation Clinic (S.B., U.S., I.K., L.K., C.J., U.F.), Vienna, Austria; Institute of Pathology and Bacteriology, Rudolf Foundation Clinic (H.F.), Vienna, Austria; Institute for Histology and Embryology, Department of Cellbiology and Ultrastructioral Research, University Clinic (M.P.), Vienna, Austria; University Eye Clinic Vienna, AKH, Währinger Gürtel 18-20 (A.K.), Vienna, Austria; Institute for Biometrie, Rheinisch-Westfälische Technische Hochschule Aachen (R.-D.H.), Germany; and Institute of Clinical Chemistry, Rudolf Foundation Clinic (W.K.), Vienna, Austria
Margit Povelka, MD
- Department of Ophthalmology, The Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Rudolf Foundation Clinic (S.B., U.S., I.K., L.K., C.J., U.F.), Vienna, Austria; Institute of Pathology and Bacteriology, Rudolf Foundation Clinic (H.F.), Vienna, Austria; Institute for Histology and Embryology, Department of Cellbiology and Ultrastructioral Research, University Clinic (M.P.), Vienna, Austria; University Eye Clinic Vienna, AKH, Währinger Gürtel 18-20 (A.K.), Vienna, Austria; Institute for Biometrie, Rheinisch-Westfälische Technische Hochschule Aachen (R.-D.H.), Germany; and Institute of Clinical Chemistry, Rudolf Foundation Clinic (W.K.), Vienna, Austria
Ursula Frohner, CN
- Department of Ophthalmology, The Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Rudolf Foundation Clinic (S.B., U.S., I.K., L.K., C.J., U.F.), Vienna, Austria; Institute of Pathology and Bacteriology, Rudolf Foundation Clinic (H.F.), Vienna, Austria; Institute for Histology and Embryology, Department of Cellbiology and Ultrastructioral Research, University Clinic (M.P.), Vienna, Austria; University Eye Clinic Vienna, AKH, Währinger Gürtel 18-20 (A.K.), Vienna, Austria; Institute for Biometrie, Rheinisch-Westfälische Technische Hochschule Aachen (R.-D.H.), Germany; and Institute of Clinical Chemistry, Rudolf Foundation Clinic (W.K.), Vienna, Austria
Andreas Kruger, MD
- Department of Ophthalmology, The Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Rudolf Foundation Clinic (S.B., U.S., I.K., L.K., C.J., U.F.), Vienna, Austria; Institute of Pathology and Bacteriology, Rudolf Foundation Clinic (H.F.), Vienna, Austria; Institute for Histology and Embryology, Department of Cellbiology and Ultrastructioral Research, University Clinic (M.P.), Vienna, Austria; University Eye Clinic Vienna, AKH, Währinger Gürtel 18-20 (A.K.), Vienna, Austria; Institute for Biometrie, Rheinisch-Westfälische Technische Hochschule Aachen (R.-D.H.), Germany; and Institute of Clinical Chemistry, Rudolf Foundation Clinic (W.K.), Vienna, Austria
Ralf-Dieter Hilgers, MS
- Department of Ophthalmology, The Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Rudolf Foundation Clinic (S.B., U.S., I.K., L.K., C.J., U.F.), Vienna, Austria; Institute of Pathology and Bacteriology, Rudolf Foundation Clinic (H.F.), Vienna, Austria; Institute for Histology and Embryology, Department of Cellbiology and Ultrastructioral Research, University Clinic (M.P.), Vienna, Austria; University Eye Clinic Vienna, AKH, Währinger Gürtel 18-20 (A.K.), Vienna, Austria; Institute for Biometrie, Rheinisch-Westfälische Technische Hochschule Aachen (R.-D.H.), Germany; and Institute of Clinical Chemistry, Rudolf Foundation Clinic (W.K.), Vienna, Austria
Walter Krugluger, MD
- Department of Ophthalmology, The Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Rudolf Foundation Clinic (S.B., U.S., I.K., L.K., C.J., U.F.), Vienna, Austria; Institute of Pathology and Bacteriology, Rudolf Foundation Clinic (H.F.), Vienna, Austria; Institute for Histology and Embryology, Department of Cellbiology and Ultrastructioral Research, University Clinic (M.P.), Vienna, Austria; University Eye Clinic Vienna, AKH, Währinger Gürtel 18-20 (A.K.), Vienna, Austria; Institute for Biometrie, Rheinisch-Westfälische Technische Hochschule Aachen (R.-D.H.), Germany; and Institute of Clinical Chemistry, Rudolf Foundation Clinic (W.K.), Vienna, Austria

Accepted 1 November 2001.

Abstract

PURPOSE: To describe the indications, surgical technique, and clinical results of 14 eyes in 13 patients with age-related macular degeneration and foveal choroidal neovascularization, in which subretinal surgery was combined with simultaneous transplantation of autologous retinal pigment epithelial cells.

METHODS: Between March 1999 and February 2000, in a prospective study, 14 eyes (13 patients) with age-related macular degeneration underwent subretinal surgery because of foveal choroidal neovascularization with simultaneous transplantation of retinal pigment epithelium harvested from the nasal subretinal area of the same eye. Preoperatively, 1 month postoperatively, 3 months postoperatively and at 3-month intervals thereafter, examinations were performed including best-corrected visual acuity, visual field, biomicroscopy of anterior and posterior segment, tonometry, fluorescein and indocyanine angiographies, autofluorescence, scotometry, and fixation tests.

RESULTS: Postoperatively, after median observation of 17 months (range, 12 to 24 months) best-corrected visual acuity was improved 2 or more lines in eight eyes (57.1%), remained the same (± 1 line) in five eyes (35%), and decreased by more than 2 lines in one eye (7.1%). Pairwise t test showed significant improvement after 1 month (P = .0031, P = .0062) as well as 1 year (P = .0066, P = .0105). Satisfactory reading vision between Jaeger 1 and 4 was achieved in three eyes (21.2%). No significant intraoperative or postoperative complications occurred in any eye. No recurrence of choroidal neovascularization was observed during the observation period.

CONCLUSIONS: In eyes with age-related macular degeneration and foveal choroidal neovascularization, autotransplantation of retinal pigment epithelium was performed in addition to conventional removal of the choroidal neovascularization without significant intraoperative or postoperative complications. Visual acuity improvement of 2 or more lines in 57% of the eyes was achieved. No recurrent choroidal neovascularization formation was observed during the observation period. The results of this pilot study suggest that autologous transplantation of retinal pigment epithelium combined with submacular surgery might be a reasonable treatment option for patients with foveal choroidal neovascularization secondary to age-related macular degeneration.