Transplantation of fetal retinal pigment epithelium in age-related macular degeneration with subfoveal neovascularization

  • Peep V. Algvere
  • Lennart Berglin
  • Peter Gouras
  • Yaohua Sheng
Clinical Investigations


Background: Age-related macular degeneration (ARMD) is caused by abnormal retinal pigment epithelium (RPE) and may be complicated by choroidal neovascularization. The object of treatment would be to replace the diseased RPE with normal human RPE. • Method: Five patients with ARMD (preoperative visual acuity 0.08–0.2) underwent removal of subretinal fibrovascular membranes using pars plana vitrectomy techniques. Human fetal RPE (15–17 weeks gestational age) was cultured and transplanted as a monolayer patch into the subretinal space. Transplants were followed by funduscopy and fluorescein angiography. Macular function was assessed using scanning laser ophthalmoscopic (SLO) microperimetry. • Results: Three RPE transplants were placed in the fovea; two were placed parafoveally. All transplants have survived for 3 months. They have grown and increased in size covering part of the epithelial defect caused by removal of the fibrovascular membrane. SLO microperimetry indicated that visual function was present in four of the transplants at 1 month but in only two at 3 months after surgery. Function over the transplants, especially those in the fovea, was compromised by cystoidlike macular edema. • Conclusions: Human fetal RPE transplants survive well in the macula for as long as 3 months. They are capable of growing to cover epithelial defects caused by removal of subretinal neovascular membranes. The causes for development of macular edema in transplants directly in the fovea warrant further evaluation.


Retinal Pigment Epithelium Macular Edema Fluorescein Angiography Choroidal Neovascularization Epithelial Defect 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Connor TB Jr, Pulido JS (1993) Management of aphakic and pseudophakic cystoid macular edema. Curr Opin Ophthalmol 4:90–101Google Scholar
  2. 2.
    Gouras P, Cao H, Sheng Y, Tanabe T, Efremova Y, Kjeldbye H (1994) Patch culturing and transfer of human fetal retinal epithelium. Graefe's Arch Clin Exp Ophthalmol 232:599–607Google Scholar
  3. 3.
    Green WR (1991) Clinicopathologic studies of treated choroidal neovascular membranes: a review and report of two cases. Retina 11:328–356Google Scholar
  4. 4.
    Hogan MJ (1972) Role of the retinal pigment epithelium in macular disease. Trans Am Acad Ophthalmol Otolaryngeol 76:64–80Google Scholar
  5. 5.
    Jiang LQ, Hamasaki D (1994) The immunological barrier to successful rescue of visual function in RCS rats. Invest Ophthalmol Vis Sci 35:1525Google Scholar
  6. 6.
    Jiang LQ, Jorquera M, Streilein JW (1993) Subretinal space and vitreous cavity as immunologically privileged sites for retinal allografts. Invest Ophthalmol Vis Sci 34:3347–3354Google Scholar
  7. 7.
    Li L, Turner JE (1991) Optimal conditions for long-term photoreceptor cell rescue in RCS rat: the necessity for healthy RPE transplants. Exp Eye Res 52:669–679Google Scholar
  8. 8.
    Lopez PF, Grossniklaus HE, Lambert M, Aaberg TM, Capone A Jr, Sternberg P Jr, L'Hernault N (1991) Pathological features of surgically excised subretinal neovascular membranes in age-related macular degeneration. Am J Ophthalmol 112:647–656Google Scholar
  9. 9.
    Macular Photocoagulation Study Group (1991) Laser photocoagulation of subfoveal neovascular lesions in age-related macular degeneration: results of a randomized clinical trial. Arch Ophthalmol 109:1220–1231Google Scholar
  10. 10.
    Peyman GA, Blinder KJ, Paris CL, Alturki W, Nelson NC, Desai U (1991) A technique for retinal pigment epithelium transplantation for age-related macular degeneration secondary to extensive subfoveal scarring. Ophthalmic Surg 22:102–108Google Scholar
  11. 11.
    Sarks SH (1976) Aging and degeneration in the macular region: a clinicopathological study. Br J Ophthalmol 60:324–341Google Scholar
  12. 12.
    Seregard S, Algvere PV, Berglin L (1994) Immunohistochemical characterization of surgically removed subfoveal fibrovascular membranes. Graefe's Arch Clin Exp Ophthalmol 232:325–329Google Scholar
  13. 13.
    Sheng Y, Gouras P, Cao H, Kjeldbye H, Rosskothen H, Berglin L (1994) Patch transplants of human fetal retinal pigment epithelium in rabbit and monkey retina. Invest Ophthalmol Vis Sci (in press)Google Scholar
  14. 14.
    Thomas MA (1994) The management of subfoveal choroidal neovascularization with vitreoretinal surgery. In: Lewis H, Ryan SJ (eds). Medical and surgical retina. Mosby, St. Louis, pp 63–81Google Scholar
  15. 15.
    Thomas MA, Kaplan HJ (1991) Surgical removal of subfoveal neovascularization in the presumed ocular histoplasmosis syndrome. Am J Ophthalmol 111:1–7Google Scholar
  16. 16.
    Yamamoto S, Du J, Gouras P, Kjeldbye H (1993) Retinal pigment epithelial transplants and retinal function in RCS rats. Invest Ophthalmol Vis Sci 34:3068–3075Google Scholar
  17. 17.
    Yanoff M, Fine BS, Brooker AS, Eagle RC Jr (1984) Pathology of cystoid macular edema. Surv Ophthalmol 28:505–511Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • Peep V. Algvere
    • 1
  • Lennart Berglin
    • 2
  • Peter Gouras
    • 2
  • Yaohua Sheng
    • 2
  1. 1.Department of Ophthalmology, Karolinska InstituteSt. Erik's Eye HospitalStockholmSweden
  2. 2.Department of OphthalmologyColumbia UniversityNew YorkUSA

Personalised recommendations