Lappas A, Weinberger A W, Foerster A M, Kube T, Rezai K A, Kirchhof B
Augenklinik, Universitätsklinikum der RWTH Aachen, Germany.
Graefes Arch Clin Exp Ophthalmol. 2000 Aug;238(8):631-41. doi: 10.1007/s004170000149.
This prospective, non-controlled pilot study investigates the practicability of IPE translocation and functional outcome in ARMD patients. Removal of submacular choroidal neovascularization (CNV) in age-related macular degeneration (ARMD) is usually associated with RPE damage and poor visual prognosis. Homologous RPE transplants fail to preserve macular function, 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 RPE functions in the experimental animal. Immunological cell rejection is avoided.
Four eyes with well-defined and eight eyes with ill-defined subfoveal CNV were submitted to operation and followed up for a minimum of 6 months. 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 acuity, fluorescein angiography, and SLO microperimetry.
All patients underwent successful surgical removal of CNV and subretinal IPE injection. Compared to preoperative visual acuity (20/400-20/100) no significant change was observed after 6 months (20/320-16/80). A change of more than two ETDRS chart lines was defined as significant. One eye with preoperative ill-defined CNV developed a recurrence, leading to reduced visual acuity. In all patients, postoperative fluorescence angiography revealed early hyperfluorescence (window defect) in the surgically denuded area. Central fixation was demonstrated in 50% of eyes.
Preliminary data suggests that IPE translocation in submacular surgery for ARMD can preserve but not improve preoperative visual acuity over 6 months. Functional results are promising compared to submacular membrane extraction alone and RPE transplantation. Continued research on improvement of IPE translocation seems justified.
这项前瞻性、非对照性的试点研究探讨了虹膜色素上皮（IPE）转位术在年龄相关性黄斑变性（ARMD）患者中的可行性及功能预后。年龄相关性黄斑变性（ARMD）患者黄斑下脉络膜新生血管（CNV）的清除通常与视网膜色素上皮（RPE）损伤及不良的视力预后相关。同种异体RPE移植未能保留黄斑功能，可能是由于免疫排斥反应。基于早期动物和体外研究的证据表明IPE可在实验动物中替代RPE功能，我们建议转位自体虹膜色素上皮（IPE），从而避免免疫细胞排斥反应。
对4只黄斑下CNV边界清晰的眼睛和8只黄斑下CNV边界不清晰的眼睛进行手术，并随访至少6个月。从周边虹膜切除术获取IPE细胞。进行玻璃体切除术。切除黄斑下膜，并将分离的IPE细胞注入视网膜下间隙。检查包括早期糖尿病性视网膜病变研究组（ETDRS）视力、荧光素血管造影和扫描激光眼底镜（SLO）微视野检查。
所有患者均成功进行了CNV手术切除及视网膜下IPE注射。与术前视力（20/400 - 20/100）相比，6个月后未观察到显著变化（20/320 - 16/80）。ETDRS视力表上变化超过两行被定义为有显著变化。1只术前黄斑下CNV边界不清晰的眼睛出现复发，导致视力下降。在所有患者中，术后荧光血管造影显示手术剥脱区域早期高荧光（窗样缺损）。50%的眼睛显示中心注视。
初步数据表明，ARMD黄斑下手术中的IPE转位术可在6个月内维持但不能提高术前视力。与单纯黄斑下膜切除术和RPE移植相比，功能结果很有前景。继续研究改进IPE转位术似乎是合理的。
