Neuroretinal
transplantation
Henry J. Kaplan¹, Adam S. Berger, MD²,
Tongalp H. Tezel, MD²,
Lucian V. Del Priore MD, PhD³
1 Departments of Ophthalmology and Visual Sciences, Kentucky Lions Eye
Center, University of Louisville, KY;
2 Washington University School of Medicine, St. Louis, MO;
3 College of Physicians and Surgeons, Columbia
University, New York, NY.
Purpose: To explore
tissue transplantation for treatment of retinitis pigmentosa (RP) and
exudative age-related macular degeneration (AMD).
Methods: Eight patients with RP underwent transplantation of adult human
cadaver photoreceptor sheets harvested with the excimer laser. No immunosuppression
was used postoperatively. Patients were followed for 12 months postoperatively.
Twelve AMD patients with subfoveal neovascularization underwent subfoveal
membranectomy with transplantation of a sheet of adult human allogeneic
RPE cells with 1 year follow-up. All patients were started on immunosuppression
postoperatively.
Results: Best corrected ETDRS visual acuity (Bailey-Lovie chart), median
reading speed, contrast sensitivity, dark adaptation and maculoscope ERG
for the operated eye was unchanged at 12 months in RP. There was no apparent
rejection of the graft. The visual acuity, contrast sensitivity, and reading
speed did not change significantly during the first year after surgery
in AMD. Patients on immune suppression for the first 6 months postoperatively
showed no signs of transplant rejection. However, 2 patients who discontinued
immune suppression within 6 months after surgery developed signs of graft
rejection.
Conclusion: Allogeneic photoreceptor transplantation is feasible and is
not associated with overt immune rejection or other significant adverse
effects. A sheet of adult human allogeneic RPE harvested from eye bank
eyes can be transplanted into the subretinal space in AMD patients at
the time of submacular surgery. Systemic immune suppression appears to
prevent rejection. The transplanted tissue did not lead to an improvement
in visual function in either group.