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Transplantation of RPE in age-related macular degeneration: Observations in disciform lesions and dry RPE atrophy

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Abstract

• A study was carried out to investigate whether human RPE allografts are tolerated or rejected in the subretinal space and to determine the feasibility of RPE transplantation in subjects with age-related macular degeneration (AMD). • Methods: Patches of human fetal RPE (13–20 weeks of gestational age) were transplanted into the subretinal space of five patients after surgical removal of subfoveal fibrovascular membranes, and to four subjects with dry geographic atrophy. Suspensions of RPE cells were transplanted to four other patients with nonexudative AMD. Results were evaluated with clinical ophthalmological examination, SLO microperimetry and fluorescein angiography over 8–20 months. • Results: In disciform lesions, RPE transplants developed macular edema and fluorescein leakage concomitant with gradual reduction of visual acuity, implying host-graft rejection, over 1–6 months. In geographic atrophy, three of four transplants showed little change in shape and size after 12 months (one transplant was slowly rejected). In non-exudative AMD, RPE suspension transplants showed no evidence of rejection and were associated with the disappearance of drusen; visual acuity remained stable and SLO microperimetry confirmed retinal function over the transplanted area. • Conclusion: Human RPE allografts are not invariably rejected in the subretinal space without immunosuppression. The rejection rate is lower in nonexudative than in neovascular AMD. An intact blood-retinal barrier is likely to protect against rejection. It is technically feasible to transplant human RPE into the submacular space without adversely affecting visual function in nonexudative AMD over relatively long periods of time

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Authors and Affiliations

  1. Department of Ophthalmology, Karolinska Institute, St. Erik's Eye Hospital, Fleminggatan 22, S-11282, Stockholm, Sweden

    Peep V. Algvere, Lennart Berglin & Eva Dafgård Kopp

  2. Department of Ophthalmology, Columbia University, New York, N.Y., USA

    Peter Gouras & Yaohua Sheng

Authors
  1. Peep V. Algvere
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  2. Lennart Berglin
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  3. Peter Gouras
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  4. Yaohua Sheng
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  5. Eva Dafgård Kopp
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Additional information

This work was supported by grants from the Swedish Medical Research Council (B96-12X-11561-01A) and the Crown Princess Margareta Foundation, Stockholm, Sweden.

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Algvere, P.V., Berglin, L., Gouras, P. et al. Transplantation of RPE in age-related macular degeneration: Observations in disciform lesions and dry RPE atrophy. Graefe's Arch Clin Exp Ophthalmol 235, 149–158 (1997). https://doi.org/10.1007/BF00941722

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  • DOI: https://doi.org/10.1007/BF00941722

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