Klin Monbl Augenheilkd 2017; 234(09): 1082-1087
DOI: 10.1055/s-0043-111802
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Zelltransplantation zur Behandlung der altersabhängigen Makuladegeneration

Cell Transplantation in Age-related Macular Degeneration
Bernd Kirchhof
Netzhaut- und Glaskörperchirurgie, Medizinische Fakultät der Universität zu Köln
› Institutsangaben
Weitere Informationen

Publikationsverlauf

eingereicht 21. April 2017

akzeptiert 02. Mai 2017

Publikationsdatum:
27. Juli 2017 (online)

Zusammenfassung

Den Startschuss zur Chirurgie der Makuladegeneration gibt Robert Machemer mit seiner Netzhautdrehung. Über die Transplantation von retinalem Pigmentepithel liegt in Europa schon umfassende experimentelle und klinische Erfahrung vor. Im Mittel kann man den Ausgangsvisus erhalten. Solange die photodynamische Therapie die Standardtherapie der exsudativen AMD ist, können Transplantationsverfahren bestehen. Die photodynamische Therapie kann die Verschlechterung des Visus lediglich verlangsamen. VEGF-Blocker haben heute Priorität, weil sie die funktionelle Prognose im Mittel sogar verbessern können. Allerdings wird aktuell deutlich, dass die Sehverbesserung durch VEGF-Blocker lediglich über etwas mehr als 2 Jahre aufrechterhalten werden kann. Deshalb mögen in Zukunft Zelltransplantationen mit neuen Zellen und geringerem Operationsrisiko wieder erwogen werden. Dabei mögen die homologen RPE-Stammzellen als „Sheet“ oder als Einzelzellsuspension infrage kommen. Für die trockene AMD ist nur die Frühoperation vorstellbar, solange wir die Degeneration auf der Netzhautseite nicht zurückdrehen können.

Abstract

Robert Machemer offers a surgical approach to age-related macular degeneration with his retinal rotation. There is already considerable experimental and clinical knowledge available in Europe and the US on transplantation techniques for age-related macular degeneration. On average, initial visual acuity can be preserved. When photodynamic therapy was standard for exudative AMD, transplantation was superior. Photodynamic therapy could not stop, but was instead able to slow down visual loss. Currently, VEGF-blocker therapy has priority, because the visual acuity can be improved. However, this advantage does not last much longer than two years. Therefore, in the future, transplantation with new cells and less surgical risk may be reconsidered. At present, homologous RPE stem cells show promising results. They may be delivered as “sheets” or as single cells. For dry AMD only, a prophylactic approach seems reasonable, because, thus far, we are unable to reverse the atrophy on the retinal side.

 
  • Literatur

  • 1 Peyman GA, Blinder KJ, Paris CL. et al. A technique for retinal pigment epithelium transplantation for age-related macular degeneration secondary to extensive subfoveal scarring. Ophthalmic Surg 1991; 22: 102-108
  • 2 Lappas A, Weinberger AW, Foerster AM. et al. Iris pigment epithelial cell translocation in exudative age-related macular degeneration. A pilot study in patients. Graefes Arch Clin Exp Ophthalmol 2000; 238: 631-641
  • 3 Van Meurs JC, Van Den Biesen PR. Autologous retinal pigment epithelium and choroid translocation in patients with exudative age-related macular degeneration: short-term follow-up. Am J Ophthalmol 2003; 136: 688-695
  • 4 Van Meurs JC, ter Averst E, Hofland LJ. et al. Autologous peripheral retinal pigment epithelium translocation in patients with subfoveal neovascular membranes. Br J Ophthalmol 2004; 88: 110-113
  • 5 Joussen AM, Heussen FM, Joeres S. et al. Autologous translocation of the choroid and retinal pigment epithelium in age-related macular degeneration. Am J Ophthalmol 2006; 142: 17-30
  • 6 Treumer F, Bunse A, Klatt C. et al. Autologous retinal pigment epithelium-choroid sheet transplantation in age related macular degeneration: morphological and functional results. Br J Ophthalmol 2007; 91: 349-353
  • 7 Heussen FM, Fawzy NF, Joeres S. et al. Autologous translocation of the choroid and RPE in age-related macular degeneration: 1-year follow-up in 30 patients and recommendations for patient selection. Eye (Lond) 2008; 22: 799-807
  • 8 Alexander P, Thomson HA, Luff AJ. et al. Retinal pigment epithelium transplantation: concepts, challenges, and future prospects. Eye (Lond) 2015; 29: 992-1002
  • 9 Grunwald JE, Pistilli M, Ying GS. et al. Growth of geographic atrophy in the comparison of age-related macular degeneration treatments trials. Ophthalmology 2015; 122: 809-816
  • 10 Williams DF, Yaspan B, Zhengrong L. et al. Lampalizumab (anti-factor D) in Geographic Atrophy: the MAHALO Phase II Results. Presented at the 2013 American Society of Retina Specialists (ASRS) Meeting; August 27, 2013; Toronto, ON, Canada.
  • 11 Machemer R. Macular translocation. Am J Ophthalmol 1998; 125: 698-700
  • 12 Li LX, Turner JE. Inherited retinal dystrophy in the RCS rat: prevention of photoreceptor degeneration by pigment epithelial cell transplantation. Exp Eye Res 1988; 47: 911-917
  • 13 Eckardt C, Eckardt U. Macular translocation in nonexudative age-related macular degeneration. Retina 2002; 22: 786-794
  • 14 Rezai KA, Kohen L, Wiedemann P. et al. Iris pigment epithelium transplantation. Graefes Arch Clin Exp Ophthalmol 1997; 235: 558-562
  • 15 Lappas A, Foerster AM, Weinberger AW. et al. Translocation of iris pigment epithelium in patients with exudative age-related macular degeneration: long-term results. Graefes Arch Clin Exp Ophthalmol 2004; 242: 638-647
  • 16 Ho TC, Del Priore LV. Reattachment of cultured human retinal pigment epithelium to extracellular matrix and human Bruchʼs membrane. Invest Ophthalmol Vis Sci 1997; 38: 1110-1118
  • 17 Warre-Cornish K, Barber AC, Sowden JC. et al. Migration, integration and maturation of photoreceptor precursors following transplantation in the mouse retina. Stem Cells Dev 2014; 23: 941-954
  • 18 Binder S, Stolba U, Krebs I. et al. Transplantation of autologous retinal pigment epithelium in eyes with foveal neovascularization resulting from age-related macular degeneration: a pilot study. Am J Ophthalmol 2002; 133: 215-225
  • 19 Lopez R, Gouras P, Brittis M. et al. Transplantation of cultured rabbit retinal epithelium to rabbit retina using a closed-eye method. Invest Ophthalmol Vis Sci 1987; 28: 1131-1137
  • 20 Bertolotti E, Neri A, Camparini M. et al. Stem cells as source for retinal pigment epithelium transplantation. Prog Retin Eye Res 2014; 42: 130-144
  • 21 Joussen AM, Joeres S, Fawzy N. et al. Autologous translocation of the choroid and retinal pigment epithelium in patients with geographic atrophy. Ophthalmology 2007; 114: 551-560
  • 22 Kirchhof B. Patch-Transplantation bei trockener AMD. Im Internet: http://www.eyemoviepedia.com/videos/4166636950/67 Stand: 01.06.2009
  • 23 Schwartz SD, Tan G, Hosseini H. et al. Subretinal transplantation of embryonic stem cell-derived retinal pigment epithelium for the treatment of macular degeneration: an assessment at 4 years. Invest Ophthalmol Vis Sci 2016; 57: ORSFc1-9
  • 24 Kirchhof B, Schaub F, Fauser S. Prophylactic intravitreal 5-fluorouracil and heparin to prevent PVR in high-risk patients with retinal detachment. (privent). Im Internet: https://clinicaltrials.gov/ct2/show/NCT02834559 Stand: 11.06.2017
  • 25 Van Zeeburg EJ, Maaijwee KJ, Missotten TO. et al. A free retinal pigment epithelium-choroid graft in patients with exudative age-related macular degeneration: results up to 7 years. Am J Ophthalmol 2012; 153: 120-127
  • 26 Stanzel BV, Liu Z, Somboonthanakij S. et al. Human RPE stem cells grown into polarized RPE monolayers on a polyester matrix are maintained after grafting into rabbit subretinal space. Stem Cell Reports 2014; 2: 64-77
  • 27 Dintelmann TS, Heimann K, Kayatz P. et al. Comparative study of ROS degradation by IPE and RPE cells in vitro. Graefes Arch Clin Exp Ophthalmol 1999; 237: 830-839
  • 28 Schwartz SD, Regillo CD, Lam BL. et al. Human embryonic stem cell-derived retinal pigment epithelium in patients with age-related macular degeneration and Stargardtʼs macular dystrophy: follow-up of two open-label phase 1/2 studies. Lancet 2015; 385: 509-516
  • 29 Strauss RW, Ho A, Muñoz B. et al. The natural history of the Progression of Atrophy Secondary to Stargardt Disease (ProgStar) Studies: design and baseline characteristics: ProgStar Report No. 1. Ophthalmology 2016; 123: 817-828
  • 30 Plank T, Rosengarth K, Schmalhofer C. et al. Perceptual learning in patients with macular degeneration. Front Psychol 2014; 5: 1189
  • 31 Joussen AM, Kirchhof B. Surgery for age-related macular degeneration. Still an option in the age of pharmacotherapy?. Klin Monatsbl Augenheilkd 2014; 231: 874-882