Long-term outcome of RPE allografts in non-immunosuppressed patients with AMD
Long-term outcome of RPE allografts in non-immunosuppressed patients with AMD
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DOI：
10.1177/112067219900900310
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发表时间：
1999-07-01
影响因子：
1.7
通讯作者：
Kopp, ED
中科院分区：
文献类型：
--
作者：
Algvere, PV;Gouras, P;Kopp, ED
目的。确定人视网膜色素上皮 (RPE) 移植治疗晚期年龄相关性黄斑变性 (AMD) 患者的长期结果。方法。利用睫状体平坦部显微外科技术，将同种异体 RPE 移植到四组 AMD 患者的视网膜下：其中 5 名患者在去除脉络膜新生血管膜后接受了有组织的补片移植，4 名患者在干性 AMD 中接受了小补片移植； 5 名干性 AMD 患者和 2 名 RPE 撕裂患者接受了 RPE 细胞悬浮液移植。没有人接受免疫抑制。通过生物显微镜、眼底照相、SLC 显微视野检查和荧光素血管造影对移植进行 24-38 个月的随访。排斥被定义为移植物视觉功能丧失、渗出反应（视网膜下液伴或不伴新生血管形成）、荧光素渗漏以及移植物破坏、脱色或封装。结果。 16 例移植中的 4 例（25%）没有出现排斥反应的临床症状。 4 个小斑块移植物中的 3 个在 30-32 个月后仍保持色素且基本没有变化。所有新生血管性 AMD（血视网膜屏障破坏，BRB）病例均在三个月内出现移植排斥的临床症状，但非渗出性 AMD（完整 BRB）的 9 只眼睛中有 5 只在 6 - 20 个月后出现。结论。视网膜下人 RPE 同种异体移植物在没有免疫抑制的情况下表现出很高的排斥率 (75%)。然而，在非渗出性 AMD 中，小型中央凹外移植物的形状、大小和颜色在两年多的时间内保持不变。破坏的 BRB 可能会增强移植排斥，渗出性 AMD 的排斥反应比非渗出性 AMD 更早发生。
Purpose. To determine the long-term outcome of human retinal pigment epithelium (RPE) transplants in patients with advanced age-related macular degeneration (AMD). Methods. Using pars plana microsurgical techniques, RPE allografts were transplanted sub-retinally to four groups of AMD patients: five patients received organized patch transplants after removal of choroidal neovascular membranes, four got small patch transplants in dry AMD; suspensions of RPE cells were transplanted in five cases with dry AMD, and two patients with RPE tears. None received immunosuppression. Transplants were followed for 24-38 months by biomicroscopy, fundus photography, SLC microperimetry, and fluorescein angiography. Rejection was defined as loss of visual function over the transplant, development of an exudative response (subretinal fluid with or without neovascularization), fluorescein leakage, and disruption, depigmentation, or encapsulation of the transplant. Results. Four of 16 transplants (25%) presented no clinical signs of rejection. Three of the four small patch transplants remained pigmented and essentially unchanged after 30-32 months. Clinical signs of graft rejection appeared within three months in all cases of neovascular AMD (disrupted blood-retinal barrier, BRB), but after 6 - 20 months in five of nine eyes with non-exudative AMD (intact BRB).Conclusions. Subretinal human RPE allografts present a high rejection rate (75%) without immunosuppression. However, small extrafoveal transplants remained unchanged in shape, size and color for more than two years in non-exudative AMD. A disrupted BRB is likely to enhance graft rejection, which occurs earlier in exudative than in non-exudative AMD.