Human Retinal Pigment Epithelium Transplantation: Outcome after Autologous RPE-Choroid Sheet and RPE Cell-Suspension; A Randomized Clinical Study.

Christiane Isolde Falkner-Radler (1) , Ilse Krebs (1) , Carl Glittenberg (1) , Boris Považay (2) , Wolfgang Drexler (2) , Alexandra Graf (3) , Susanne Binder (1)

1 LBI of Retinology and Biomicroscopic Laser surgery, Dep. of Ophthalmology, Rudolf Foundation Clinic
2 Cardiff University
3 Medizinische Universität Wien = Medical University of Vienna

Aims: To evaluate the outcome after two types of retinal pigment epithelium (RPE) transplantation techniques. Methods: Fourteen consecutive patients with advanced exsudative age-related macular degeneration (AMD) were randomly assigned to RPE-choroid sheet transplantation (group 1) or RPE cell-suspension transplantation (group 2). Outcome measurers included best–corrected distance and near visual acuity (BCVA), complication and recurrence rates, autofluorescence (AF), angiography, and time-domain (TD) and spectral-domain optical coherence tomography (SD-OCT). Results: A three or more lines gain in BCVA at 24 months was found in two patients in group 1 and in one patient in group 2, whereas a three or more lines vision loss occurred in one patient in each group. Revision surgery for proliferative vitreoretinopathy was required in one patient in group 1. Epiretinal membranes developed in two patients in group 1 and in one patient in group 2. No recurrence occurred in this series. AF showed hyperfluorescence coincident with the graft in group 1, and hyper- and hypofluorescence in irregular patterns in group 2. Revascularization of the graft was present in all patients in group 1, and a normal choroidal vasculature in the area of RPE atrophy in all patients in group 2. OCT showed a decrease of retinal thickness in all patients, with an improved visualization of inter- and intralaminar structures in the SD-OCT. Conclusion: The anatomic and functional outcome after both RPE transplantation techniques was comparable. Intrastructural irregularities of the sheet assesed using SD-OCT might explain the rather limited visual gain in otherwise successful sheet transplants.

Mots clés: Choroid; Retina; Macula; Neovascularisation; Treatment Surgery

Christiane Isolde Falkner-Radler, Ilse Krebs, Carl Glittenberg, Boris Považay, Wolfgang Drexler, et al.. Human Retinal Pigment Epithelium Transplantation: Outcome after Autologous RPE-Choroid Sheet and RPE Cell-Suspension; A Randomized Clinical Study.. British Journal of Ophthalmology, 2010, 95 (3), pp.370. ⟨10.1136/bjo.2009.176305⟩. ⟨hal-00567048⟩