August 24, 2004.
A patient with retinitis pigmentosa (RP) experienced significant improvement in vision after being transplanted with a sheet of fetal neural retina with its retinal pigment epithelium, investigators report.
Dr. Norman D. Radtke, at the University of Louisville in Kentucky, and colleagues performed the transplant on a 64-year-old woman with RP whose visual acuity in the treated eye was 20/800 at baseline.
The 1.5 x 3.1-mm piece of retina, obtained from a fetus of 13 weeks' gestational age, was placed into the subretinal space under the fovea. The surgeons used a specialized instrument designed to maintain the correct orientation of the retinal sheet while causing a minimum of trauma.
"By 1 year postoperatively, no graft encapsulation, tissue destruction, or macular edema indicating rejection was seen clinically or with fluorescein angiography," Dr. Radtke's group reports in the August Archives of Ophthalmology.
There were increases in anti-major histocompatibility complex class I antibodies beginning 3 months after surgery, but no donor-specific antibodies. The investigators also observed that heavy pigmentation of the donor tissue disappeared between 3 and 6 months after transplantation.
Scanning laser ophthalmoscopy demonstrated visual acuity of 20/400 at 6 months and 20/160 at 12 months. Since the manuscript was submitted, the patient has also reported subjective improvement. At 2 years 2 months, the authors note, she could read a large-print book and print on the computer, but only with the operated eye.
"Diseases that affect the retinal pigment epithelium and photoreceptor cells of the retina (eg, RP, age-related macular degeneration, rod-cone dystrophy, and Stargardt disease) might conceivably benefit from this type of transplantation in the future," Dr. Radtke's group concludes.
Arch Ophthalmol 2004;122:1159-1165.
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