Narendra Armogan, MD, FRCS(C) (Mississauga, Canada), Fareed Ali, MD, FRCS(C) (Toronto, Canada), Alan Kosaric, MD (Oakville, Canada)

PURPOSE:

Can Autologous Iris Pigment Cell transplantation for Dry Macular Degeneration be used as a treatment to prevent the relentless progression of the disease as measured by functional and structural analysis; additionally, can improvement of visual acuity in patients by virtue of rescuing neuro-retinal cells with IPE cells which have retinal stem cell potential in adult human tissue be seen?

METHODS:

Patients with dry macular degeneration and significant RPE cell atrophy who demonstrated functional retinal decline were enrolled in this prospective trial over a 4 year period. Fifteen patients were enrolled into the trial with clear evidence of  visual function deterioration and offered surgical transplantation. At the time of vitrectomy, harvested autologous iris pigment epithelium cells were suspended into solution and transplanted into the subretinal space, patients were then followed with visual acuity measurments, fluorescein angiography, OCT and microperimetry.

RESULTS:

Demonstration of iris pigment cells in the subretinal space, following vitrectomy, when they may lose pigmentation was seen on fluorescein angiography in >20% of cases. Compared to preoperative measurements of visual funciton decline over the preceding 6 months (100%), the majority of paitents demonstrated stabilization of vision (>70%) following transplantation with several patients having documented improvement of visual acuity (>15%). Newer functional retinal analysis including the use of microperimetry has demonstated more clearly, the improvment seen following iris pigment cell transplantation, when compared to other methods of functional retinal assesment. Complications seen at the time of  surgical intervention included those of traditional vitrectomy risks, but unique to this surgery two patients developed anterior chamber hyphema which resolved.

CONCLUSION:

The first long term study of Autologous Iris Pigment Cell Transplantation for Dry Age Related Macular Degeneration shows  that visual stabilization in patients who were deteriorating could be achieved. Additionally visual funciton improvment was seen in patients following transplantation which has persisted and is not a short term effect associated with the vitrectomy procedure.