Iris pigment epithelial cell translocation in exudative age-related macular degeneration - A pilot study in patients

Background. This prospective, non-controlled pilot study investigates the p racticability of IPE translocation and functional outcome in ARMD patients. Removal of submacular choroidal neovascularization (CNV) in age-related ma cular degeneration (ARMD) is usually associated with RPE damage and poor vi sual prognosis. Homologous RPE transplants fail to preserve macular functio n, possibly due to immune rejection. Instead of homologous RPE, we suggest translocating autologous iris pigment epithelium (IPE), building on earlier evidence from animal and in vitro investigations that IPE can substitute R PE functions in the experimental animal. Immunological cell rejection is av oided. Methods: Four eyes with well-defined and eight eyes with ill-defined subfov eal CNV were submitted to operation and followed up for a minimum of 6 mont hs. IPE cells were harvested from a peripheral iridectomy. A vitrectomy was performed. Submacular membranes were removed, and isolated IPE cells were injected into the subretinal space. Examinations included ETDRS visual acui ty, fluorescein angiography, and SLO microperimetry. Results: All patients underwent successful surgical removal of CNV and subr etinal IPE injection. Compared to preoperative visual acuity (20/400-20/100 ) no significant change was observed after 6 months (20/320-16/80). A chang e of more than two ETDRS chart lines was de fined as significant. One eye w ith preoperative ill-defined CNV developed a recurrence, leading to reduced visual acuity. In all patients, postoperative fluorescence angiography rev ealed early hyperfluorescence (window defect) in the surgically denuded are a. Central fixation was demonstrated in 50% of eyes. Conclusions: Preliminary data suggests that IPE translocation in submacular surgery for ARMD can preserve but not improve preoperative visual acuity o ver 6 months. Functional results are promising compared to submacular membr ane extraction alone and RPE transplantation. Continued research on improve ment of IPE translocation seems justified.