Adult retinal pigment epithelial transplantation in exudative age-related macular degeneration

PURPOSE: To improve visual function by retinal pig, ment epithelial (RPE) cell transplantation and systemic immunosuppression at the time of surgical removal of subfoveal choroidal neovascularization in exudative agerelated macular degeneration (AMD). center dot DESIGN: An interventional case series of RPE transplantation in exudative AMD. center dot METHODS: Twelve patients (one eye only) underwent subfoveal membranectomy with transplantation of a sheet of adult human allogeneic RPE cells at a single institution and were followed for one year. Eligibility criteria included age > 60, best,corrected acuity <= 20/63 and subfoveal neovascularization <= 9 disk areas on preop, erative fluorescein angiography. All patients were started on triple immunosuppression postoperatively. The pri, mary outcome measure was best-corrected vision, with contrast sensitivity and reading speed as secondary outcome measures. center dot RESULTS: The best-corrected visual acuity (P = .085), contrast sensitivity (P = .204), and the reading speed (P = .077) did not change significantly at one year compared with preoperative values. Transplants showed no signs of rejection in patients who were able to continue the immunosuppressants for six months. Post, operative surgical complications included cataract pro, gression requiring surgery (three of eight phakic eyes), retinal detachment (three eyes), intraoperative retinal breaks (two eyes), and macular pucker (two eyes). None of the patients developed cystoid macular edema on postoperative fluorescein angiography or postoperative inflammation. center dot CONCLUSIONS: A sheet of adult human allogeneic RPE can be transplanted into the subretinal space in AMD patients at the time of subfoveal membranectomy. Systemic immune suppression appeared to prevent rejection of the transplanted tissue, but did not lead to an improvement in visual function.