Transplantation of retinal pigment pithelium (RPE) following CNV removal in patients with AMD. Techniques, results, outlook
Transplantation of retinal pigment pithelium (RPE) following CNV removal in patients with AMD. Techniques, results, outlook
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DOI：
10.1007/s00347-004-1077-2
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发表时间：
2004-09-01
期刊：
影响因子：
--
通讯作者：
Holz, FG
中科院分区：
文献类型：
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作者：
Bindewald, A;Roth, F;Holz, FG
新生血管性年龄相关性黄斑变性（AMD）已成为所有工业化国家严重视力丧失的主要原因。手术切除脉络膜新生血管（CNV）在技术上是可行的，但总是伴随着相应的视网膜色素上皮（RPE）的意外切除和随后的脉络膜毛细血管萎缩，后两层是正常感光功能的先决条件。为了覆盖RPE缺损，异体和同源RPE细胞悬浮液被注射到视网膜下间隙。缺乏功能改善归因于多种因素，包括RPE细胞去分化，未能粘附布鲁赫膜以及常规RPE细胞单层的发育。因此，人们一直在寻找移植完整的自体RPE细胞片的技术，并且最近成功地证明了保存中央凹神经感觉功能。除了在黄斑区域外移位全层RPE/Bruch膜/脉络膜斑块外，在移位之前，可以使用准分子激光在眼内消融多余的脉络膜组织。除了最近的药理学方法，包括抗vegf药物，这些外科发展为新生血管性AMD患者开辟了新的视角。
Neovascular age-related macular degeneration (AMD) has become the leading cause for severe visual loss in all industrialized nations. Surgical excision of choroidal neovascularizations (CNV) is technically feasible but invariably associated with inadvertent removal of corresponding retinal pigment epithelium (RPE) and subsequent atrophy of the choriocapillaris, with the latter two layers being a prerequisite for normal photoreceptor function. To cover the RPE defect both heterologous and homologous RPE cell suspensions have been injected into the subretinal space. The lack of functional improvement has been attributed to various factors including RPE cell dedifferentiation, failure of adherence to Bruch's membrane as well as development of a regular RPE cell monolayer. Therefore, techniques for translocating intact autologous RPE cell sheets have been sought and preservation of foveal neurosensory functions has recently been successfully demonstrated. Besides translocation of a full-thickness RPE/Bruch's membrane/choroid patch outside the macular area, superfluous choroidal tissue may be ablated intraocularly using an excimer laser prior to translocation. Besides recent pharmacological approaches including anti-VEGF agents, these surgical developments open new perspectives for patients with neovascular AMD.