Rizzo Stanislao, Caporossi Tomaso, Tartaro Ruggero, Finocchio Lucia, Pacini Bianca, Bacherini Daniela, Virgili Gianni
Department of Ophthalmology, Catholic University of Sacred Hearth-Foundation "Policlinico Universitario A. Gemelli"-IRCCS, Rome, Italy.
Department of NEUROFARBA, Ophthalmology, University of Florence-Careggi, Florence, Italy.
Ophthalmol Retina. 2020 Oct;4(10):996-1007. doi: 10.1016/j.oret.2020.04.017. Epub 2020 Apr 25.
Age-related macular degeneration (AMD) is the leading cause of legal blindness in adults 65 years of age and older. Choroidal neovascularization (CNV) can complicate AMD and lead to severe visual acuity reduction. Despite the several treatments available, if the retinal pigment epithelium is damaged, we have to cope with the impossibility of restoring acceptable visual acuity using only medical treatments.
Prospective, consecutive, interventional study.
Eleven patients affected by AMD, 6 patients affected by CNV, and 5 patients affected by geographic atrophy.
All patients underwent a pars plana vitrectomy with subretinal implantation of human amniotic membrane (hAM) to induce photoreceptor regeneration and partial visual acuity restoration.
Primary study outcome was visual acuity improvement. Secondary outcomes were multimodal imaging results.
Mean preoperative best-corrected visual acuity (BCVA) was 20/2000 (2 logarithm of the minimum angle of resolution [logMAR]), and all the patients showed a BCVA of counting fingers or less. Mean final BCVA was 20/400 (1.31 logMAR), ranging from 20/2000 to 20/100 (2-0.7 logMAR). OCT angiography was used to measure retinal vascularization in the treated eye compared with the fellow eye. A high correlation between BCVA and deep vascular density was evidenced. Adaptive optics findings, obtained over the retinal area where the highest functionality was observed, were evaluated using microperimetry. The images showed possible photoreceptor presence over the hAM membrane.
This work supports the feasibility and safety of the hAM to promote partial retinal function restoration 6 months after surgery with visual acuity improvement. The advanced diagnostics help to understand the interaction between the hAM and photoreceptors and suggest that photoreceptor regeneration may occur.
年龄相关性黄斑变性（AMD）是65岁及以上成年人法定失明的主要原因。脉络膜新生血管（CNV）会使AMD病情复杂化并导致严重视力下降。尽管有多种治疗方法，但如果视网膜色素上皮受损，仅靠药物治疗我们将无法恢复可接受的视力。
前瞻性、连续性、干预性研究。
11例AMD患者、6例CNV患者和5例地图样萎缩患者。
所有患者均接受了经平坦部玻璃体切除术，并在视网膜下植入人羊膜（hAM）以诱导光感受器再生和部分视力恢复。
主要研究结果是视力改善。次要结果是多模态成像结果。
术前平均最佳矫正视力（BCVA）为20/2000（最小分辨角对数[logMAR]为2），所有患者的BCVA均为指数视力或更低。最终平均BCVA为20/400（1.31 logMAR），范围为20/2000至20/100（2 - 0.7 logMAR）。使用光学相干断层扫描血管造影术测量治疗眼与对侧眼的视网膜血管化情况。结果表明BCVA与深层血管密度之间存在高度相关性。使用微视野计评估在观察到最高功能的视网膜区域获得的自适应光学检查结果。图像显示hAM膜上可能存在光感受器。
这项研究支持了hAM在术后6个月促进部分视网膜功能恢复并提高视力的可行性和安全性。先进的诊断方法有助于了解hAM与光感受器之间的相互作用，并提示可能发生了光感受器再生。
