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Mandeep S. Singh, Edward J. Lee, Helen E. Jones, Bashir Ahmed, Ian M. Andolina, Peter M. Munro, Kenneth L. Grieve, George W. Aylward, Adam M. Sillito, Robert E. MacLaren; Autologous Bruch’s Membrane Rotation As A Potential Adjunct To Retinal Pigment Epithelium Cell Replacement Therapy For Age Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5848.
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Cell replacement therapy for age related macular degeneration (AMD) would likely require the restoration of a substrate to replace damaged Bruch’s membrane (BM). We examined the feasibility of autologous peripheral-to-central BM transfer via 180° RPE-BM-choroid rotation. This approach may potentially obviate the need for an artificial substrate to support newly introduced retinal pigment epithelium (RPE) cells.
Surgery was performed in rhesus macaques (N=6). A 41-gauge subretinal infusion of Ca2+ and Mg2+-free BSS Plus (Alcon) was used to induce temporal retinal detachment. Following 180° temporal retinotomy the macula was reflected nasally to reveal the RPE. Under perfluorocarbon liquid an eccentric circular or elliptical disc of RPE-BM-choroid, centred on the recurrent branch of the long posterior ciliary artery (LSPCA), was isolated from surrounding tissue. The disc was rotated 180° about this pedicle, so bringing equatorial BM to the foveal region and vice-versa. The temporal edge of the graft was apposed to the native temporal RPE-BM-choroid. The retina was reattached and stabilized with silicone oil. Serial angiography and optical coherence tomography was performed over 6 months. Neural retinal and RPE morphology at the fovea was assessed by immunohistochemistry and periodic acid-Schiff (PAS) staining for BM.
In all 6 eyes, the choroidal flap was successfully created and rotated on the recurrent LSPCA pedicle. The retina remained attached in all cases over the period of follow-up and there was evidence of epiretinal membrane formation. RPE cells and cones were lost from the macula three months after surgery. However PAS-positive BM was intact. Graft revascularisation was seen in one case.
Pedicled RPE-BM-choroid rotation is technically feasible and the procedure enables the transfer of autologous BM from the equator to the macula. Cell viability was compromised as choroidal reperfusion remains a challenge. Autologous BM rotation may be useful to provide a substrate to support macular RPE replaced by future cell therapy approaches.
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