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R.E. MacLaren, G.S. Uppal, K.S. Balaggan, A.D. Tufail, R.R. Ali, G.W. Aylward, L. DaCruz; RPE Patch Graft Auto–Transplantation in Macular Degeneration: A Prospective Cohort Study . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2693.
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To report the preliminary findings at six months of follow–up for 12 patients with age–related macular degeneration (AMD) who were ineligible for established laser treatments and underwent submacular surgery in a prospective cohort trial.
Patients with a recent AMD–related drop in visual acuity but with good foveal fixation on biomicroscopy were recruited with informed consent and ethical approval. Surgical removal of subfoveal choroidal new vessels (CNV) was combined with auto–transplantation of a full–thickness graft of the retinal pigment epithelium (RPE) and choriocapillaris, harvested through a large retinotomy from the superior equatorial retina and placed under the fovea. In three patients a sample of RPE was removed during surgery and exposed to recombinant lentivirus carrying a reporter gene for fixed time periods before being washed off and placed in culture.
Mean LogMar vision in all 12 patients pre–operatively was 0.75, but fell to 1.13 six months after surgery. Five patients developed a retinal detachment post–operatively and two had intra–operative complications. The mean LogMar vision in the five patients who had no surgical complications had improved from 0.88 to 0.69 six months after surgery. High speed angiography showed that grafts revascularised from the periphery and the degree of revascularisation was correlated to visual function as assessed by microperimetry. A minimum period of 20 minutes outside the eye was required for efficient lentiviral transduction of the RPE.
The proven principle is that visual acuity can be improved using this technique and the use of a free graft of RPE also introduces the possibility of ex vivo gene transfer within the time frame of the operation. The surgical technique needs further refinement, however, both to reduce the risk of retinal detachment and improve revascularization of the graft.
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