March 2012
Volume 53, Issue 14
Free
ARVO Annual Meeting Abstract  |   March 2012
Autologous Bruch’s Membrane Rotation As A Potential Adjunct To Retinal Pigment Epithelium Cell Replacement Therapy For Age Related Macular Degeneration
Author Affiliations & Notes
  • Mandeep S. Singh
    University of Oxford & Oxford Eye Hospital NIHR Biomedical Research Centre, Oxford, United Kingdom
    UCL Institute of Ophthalmology & Moorfields Eye Hospital NIHR Biomedical Research Centre, London, United Kingdom
  • Edward J. Lee
    UCL Institute of Ophthalmology & Moorfields Eye Hospital NIHR Biomedical Research Centre, London, United Kingdom
  • Helen E. Jones
    UCL Institute of Ophthalmology & Moorfields Eye Hospital NIHR Biomedical Research Centre, London, United Kingdom
  • Bashir Ahmed
    UCL Institute of Ophthalmology & Moorfields Eye Hospital NIHR Biomedical Research Centre, London, United Kingdom
  • Ian M. Andolina
    UCL Institute of Ophthalmology & Moorfields Eye Hospital NIHR Biomedical Research Centre, London, United Kingdom
  • Peter M. Munro
    UCL Institute of Ophthalmology & Moorfields Eye Hospital NIHR Biomedical Research Centre, London, United Kingdom
  • Kenneth L. Grieve
    Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
  • George W. Aylward
    UCL Institute of Ophthalmology & Moorfields Eye Hospital NIHR Biomedical Research Centre, London, United Kingdom
  • Adam M. Sillito
    UCL Institute of Ophthalmology & Moorfields Eye Hospital NIHR Biomedical Research Centre, London, United Kingdom
  • Robert E. MacLaren
    University of Oxford & Oxford Eye Hospital NIHR Biomedical Research Centre, Oxford, United Kingdom
    UCL Institute of Ophthalmology & Moorfields Eye Hospital NIHR Biomedical Research Centre, London, United Kingdom
  • Footnotes
    Commercial Relationships  Mandeep S. Singh, None; Edward J. Lee, None; Helen E. Jones, None; Bashir Ahmed, None; Ian M. Andolina, None; Peter M. Munro, None; Kenneth L. Grieve, None; George W. Aylward, None; Adam M. Sillito, None; Robert E. MacLaren, None
  • Footnotes
    Support  UK Medical Research Council, Wellcome Trust, NIHR Biomedical Research Centres, NMRC Singapore, Health Foundation and the Royal College of Surgeons of Edinburgh
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 5848. doi:
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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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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : 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.

Methods: : 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.

Results: : 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.

Conclusions: : 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.

Keywords: Bruch's membrane • age-related macular degeneration • vitreoretinal surgery 
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