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Purpose:We report a case of paracentral acute middle maculopathy secondary to cholesterol embolization syndrome after an endovascular aortic aneurism repair (EVAR).Methods:Functional and anatomical damage was assessed by Snellen visual acuity, fundoscopy, and optical coherence tomography.Results:A 6

Central giant cell granuloma is a rare osseous tumor affecting young patients with anatomical and functional compromise of the maxilla and mandible. Steroid injection therapy constitutes a less invasive treatment modality for disease control in selected cases. Retinal ischemia is a reported complication of multiple medical procedures, including dental interventions, and may lead to loss of vision with poor prognosis. We report a case of retinal arteriolar ischemic disease following central giant cell granuloma management with local injected corticosteroids.

Despite notable efforts and significant therapeutical advances, age-related macular degeneration remains the single most common reason for vision loss. Retinal progenitor cells (RPCs) are considered promising candidates for cellular treatments that repair and restore vision. In this allogenic study, the phenotypic profile of pig and human RPCs derived using similar manufacturing processes is compared. The long-term (12-week) survival of green fluorescent protein-pig retinal progenitor cells GFP-pRPC after subretinal transplantation into normal miniature pig (mini-pig) retina is investigated. Human eyes are both anatomically and physiologically mimicked by pig eyes, so the pig is an ideal model to show an equivalent way of delivering cells, immunological response and dosage. The phenotypic equivalency of porcine and clinically intended human RPCs was established. Thirty-nine mini-pigs are used in this study, and vehicle-injected eyes and non-injected eyes serve as controls. Six groups are given different dosages of pRPCs, and the cells are found to survive well in all groups. At 12 weeks, strong evidence of integration is indicated by the location of the grafted cells within the neuro-retina, extension of processes to the plexiform layers and expression of key retinal markers such as recoverin, rhodopsin and synaptophysin. No immunosuppression is used, and no immune response is found in any of the groups. No pRPC-related histopathology findings are reported in the major organs investigated. An initial dose of 250 k cells in 100 µl of buffer is established as an appropriate initial dose for future human clinical trials.

We report the case of a 39-year-old male patient who presented with visual loss in the right eye for 6 weeks. The best-corrected visual acuity was counting fingers in the right eye and 20/30 in the left eye. The fundus examination demonstrated a right retinal detachment inferiorly extending to the fovea and a left macular serous detachment. After multimodal imaging study, the patient was diagnosed as having a bullous variant of central serous chorioretinopathy and treated with oral spironolactone associated with adjuvant laser photocoagulation. The retinal changes resolved after 6 months. The final visual acuity was 20/20 in both eyes. RESUMO Relatamos o caso de um homem de 39 anos apresentando perda visual no olho direito há seis semanas. A melhor acuidade visual corrigida foi conta-dedos no olho direito e 20/30 no esquerdo. A fundoscopia demonstrou descolamento de retina direito inferiormente com extensão à fóvea e descolamento macular seroso à esquerda. Após estudos de imagem multimodal, o paciente foi diagnosticado com uma variante bolhosa de coriorretinopatia serosa central e tratado com espironolactona oral associada à fotocoagulação a laser adjuvante. As alterações retinianas resolveram após seis meses. A acuidade visual final foi 20/20 em ambos os olhos.

Combined hamartoma of the retina and retinal pigment epithelium is a rare, benign intraocular tumor. Hamartoma of the retina and retinal pigment epithelium has been described in the literature as a condition presenting with variable retinal damage, ranging from partial epiretinal involvement to complete distortion of the retinal layers and retinal pigment epithelium. We report the case of an 8-year-old girl presenting with longstanding strabismus who was diagnosed with Hamartoma of the retina and retinal pigment epithelium based on multimodal imaging assessment. We explored the particular imaging findings from studies using spectral-domain optical coherence tomography, fundus autofluorescence, optical coherence tomography angiography, and fluorescein angiography.

Purpose: This study aimed to analyze the concentrations, in aqueous humor, of VEGF, b-FGF, TNF, and interleukins 1, 6, 8, 10, and 12 in patients with diabetic macular edema, with and without peripheral retinal ischemia, and to analyze the variation of the levels of these molecules, during the treatment with ranibizumab.Methods: A therapeutic, prospective, randomized interventional study was carried out. Twenty-four eyes from 24 patients were studied, divided into 3 groups. Group 1, (9 eyes), patients with EMD without peripheral ischemia. Group 2 (10 eyes), patients with EMD with peripheral ischemia. Group 3, (5 eyes), control group, formed by patients without systemic and/or eye diseases. Patients in groups 1 and 2 were treated with 3 intravitreal injections of 2 mg/0.05 ml of ranibizumab, with intervals of approximately 30 days. Before performing the injections, the aqueous humor was collected. In the control group, the material was collected before the facectomy procedure. Results: During treatment, the medians of IL-6 concentrations showed a statistically significant increase, in group 1 and group 2, there was a slight decrease, not statistically significant. Interleukin 8 showed statistically significant variations in groups 1 and 2, at the end of treatment. TNF, IL-1, IL-10, and IL-12 had their concentrations practically unchanged, in both groups. VEGF showed a statistically significant reduction in groups 1 and 2 at the end of the study. B-FGF was not detected in most of the studied patients, and in those that were found, they did not present statistically significant numbers. Conclusion: There were statistically significant variations in the increase of their median levels in interleukin 6, in the group without ischemia and a decrease in VEGF in both groups. The cytokines TNF, IL-1, IL-10, and IL-12 did not show statistically significant variations.

Purpose: Study aimed to determine compliance of patients with strabismic amblyopia undergoing occlusion treatment, followed from January 1 st, 2011 to January 1 st, 2017 at an Ophthalmology Reference Center, and identify risk factors for poor compliance. Methods: Retrospective, consecutive cohort study. Compliance reported at each visit was related to visual acuity, family history, changes in occlusion schedules and in patients’ care team during treatment. The patients were divided into two groups according to the compliance: poor compliance group and compliance group (subdivided in full compliance subgroup and partial compliance subgroup). Results: Age at treatment beginning vary from 3.7 to 13.7 years, esotropia was the most frequent deviation and the occlusion was realized from 5 to 7 hours a day. Of 220 patients, compliance was achieved by 193 (87.7%), 114 (51.8%) in full compliance subgroup and 79 (35.9%) in partial compliance subgroup, and 27 do not achieved compliance (12.3%). Poor compliance was significantly related to a history of epilepsy, higher rate of suspension of treatment due to inefficacy, higher evasion rate, lower recurrence, and lower rate of maintenance of prophylactic occlusion after treatment. Good compliance was related to family history of strabismus, higher recurrence rate, and higher maintenance of prophylactic occlusion after treatment. No relations were found between poor compliance and changes in occlusion schedules or in patients’ care team during treatment. Conclusion: Compliance with occlusion treatment of strabismic ambliopia was similar to other studies that included refractive and strabismic amblyopia and not related to changes in occlusion schedules or in patients’ care team during treatment. Family history of strabismus was a protective factor. Resumo Objetivo: Determinar a adesão de pacientes com ambliopia estrabísmica submetidos a tratamento oclusivo, acompanhados em Centro de Referência em Oftalmologia do Centro-Oeste do Brasil, e identificar fatores de risco para baixa adesão. Métodos: Estudo de coorte retrospectivo e consecutivo. A adesão relatada em cada visita foi relacionada à acuidade visual, história familiar, mudanças no tempo de oclusão e na equipe de atendimento ao paciente durante o tratamento. Os pacientes foram divididos em dois grupos de acordo com a adesão: grupo de não-adesão e grupo adesão (subdividido em subgrupo adesão total e subgrupo adesão parcial). Resultados: A idade ao início do tratamento variou de 3,7 a 13,7 anos, o desvio mais frequente foi a esotropia, o tempo médio de oclusão foi de 5 a 7 horas por dia. Dos 220 pacientes, 193 (87,7%) obtiveram adesão, 114 (51,8%) no subgrupo de adesão total e 79 (35,9%) no subgrupo de adesão parcial, e 27 não aderiram (12,3%). A não-adesão foi relacionada à história de epilepsia, maior taxa de suspensão do tratamento devido à ineficácia, maior taxa de evasão, menor recorrência e menor taxa de manutenção da oclusão profilática pós tratamento. A boa adesão foi relacionada à história familiar de estrabismo, maior taxa de recorrência e maior manutenção da oclusão profilática pós tratamento. Não houve relação entre não-adesão e mudanças nos horários de oclusão ou na equipe de atendimento durante o tratamento. Conclusão: A adesão ao tratamento oclusivo da ambliopia estrabísmica foi semelhante aos estudos que incluíram ambliopia refracional e estrabísmica e não se correlacionou a mudanças no tempo de oclusão ou na equipe de atendimento. A história familiar de estrabismo foi um fator de proteção.

Central giant cell granuloma is a rare osseous tumor affecting young patients with anatomical and functional compromise of the maxilla and mandible. Steroid injection therapy constitutes a less invasive treatment modality for disease control in selected cases. Retinal ischemia is a reported complication of multiple medical procedures, including dental interventions, and may lead to loss of vision with poor prognosis. We report a case of retinal arteriolar ischemic disease following central giant cell granuloma management with local injected corticosteroids.

Purpose: This study aims to compare the anatomical success rates of vitrectomy and SF6 gas tamponade for macular hole surgery with and without postoperative face-down posturing. Methods: This was an observational, longitudinal, and retrospective case series analysis. The study included 52 eyes from 52 patients who underwent pars plana vitrectomy with trypan blue-assisted internal limiting membrane peeling and 25% SF6 tamponade for stages 2, 3, and 4 macular holes. After surgery, all patients were provided with a postoperative postural regimen: 31 patients were instructed not to maintain face-down posturing, whereas 21 were instructed to maintain face-down posturing for 7 days. The primary outcome measure was the macular hole closure rate. Statistical analysis was performed using Epi Info 7.1. Results: A total of 47 (90.3%) patients achieved hole closure. The nonface-down posturing group and face-down posturing group obtained closure rates of 90.3% and 90.4%, respectively; these rates were not significantly different. Statistical analysis revealed that no significant differences existed in sex, age, hole duration, hole stage, preoperative visual acuity, or postoperative visual acuity between the two groups. Conclusion: Our results suggest that macular hole surgery with the use of short duration gas (SF6) is safe and effective and that maintaining a postural orientation of nonface-down posturing is also safe. However, these recommendations should be assessed further in a prospective and randomized study to comprehensively delineate the associated benefits and risks.

Background To evaluate the in vivo and in vitro toxicity of a new formulation of liposome-encapsulated sirolimus (LES). Methods In vitro experiments were done using ARPE-19 and HRP cells. An MTT assay was used to determine cell metabolic activity and a TUNEL assay for detecting DNA fragmentation. In vivo experiments were conducted on New Zealand albino rabbits that received intravitreal injections of empty liposomes (EL) or different concentrations of LES. Histopathological and immunohistochemical analyses were performed on the rabbit’s eyes following injection. Results Eighteen eyes of nine rabbits were used. MTT assay cell viability was 95.04% in group 1 (12.5 µL/mL LES). 92.95% in group 2 (25 µL/mL LES), 91.59% in group 3 (50 µL/mL LES), 98.09% in group 4 (12.5 µL/mL EL), 95.20% on group 5 (50 µL/mL EL), 98.53% in group 6 (50 µL/mL EL), and 2.84% on group 8 (50 µL/mL DMSO). There was no statistically significant difference among groups 1 to 7 in cell viability (p = 1.0), but the comparison of all groups with group 8 was significant (p Conclusion A novel formulation of LES delivered intravitreally did not cause in vitro toxicity, as evaluated by MTT and TUNEL assays, nor in vivo toxicity as evaluated by histopathology and immunohistochemistry in rabbit eyes.

PURPOSE To evaluate the agreement between multimodal imaging-MI (fluorescein angiography, indocyanine green angiography, optical coherence tomography) and optical coherence tomography angiography (OCTA) in the detection of choroidal neovascularization (CNV) in patients with pigment epithelial detachment with subretinal/intraretinal fluid (PED+F) compared to patients with PED without subretinal/intraretinal fluid (PED-F). METHODS Twenty-two eyes of 15 patients were divided into two groups (PED+F and PED-F). All patients underwent MI and OCTA with manual and automatic segmentation. MI findings were compared to OCTA findings and then analysed. RESULTS In the PED+F group (10 eyes), all studied eyes demonstrated CNV in MI. In manual segmentation OCTA assessment, 9 of 10 eyes (90%) were detected with CNV. When evaluated by automatic segmentation, 8 of 10 eyes (80%) revealed the presence of CNV. In the PED-F (12 eyes) group, all eyes did not demonstrate CNV in MI and OCTA evaluations, either by manual or automatic segmentation. The agreement between MI and OCTA shows concordance (k: 0.908; 95% CI, 0.491-1.000); the evaluation of the agreement between the automatic and manual segmentation also shows concordance (k: 0.904; 95% CI, 0.488-1.000). CONCLUSION The solid agreement between the multimodal imaging regarding the ability of OCTA to identify possible initial CNV in a patient with PED-F was observed. Accuracy was 95.45%. In addition, the agreement between manual and automatic segmentation to identify CNV on OCTA was also shown.

Purpose. Xeroderma pigmentosum (XP) is a rare autosomal recessive genetic disorder characterized by increased susceptibility to UV radiation- (UVR-) induced skin pigmentation, skin cancers, ocular surface disease, and, in some patients, sunburn and neurological degeneration. Eight different genes are affected, and the prevalence of the disease differs across the world. The present study describes the main ophthalmologic features and symptoms in patients with XP in this case series. Methods. Patients were examined consecutively at the University Hospital of the Federal University of Goias between January 2016 and June 2018. All patients underwent ophthalmologic examination and were asked about their ophthalmological history and the presence of ocular symptoms. Results. Twenty-one patients with genetic confirmation were evaluated. The genetic variants XPV and XPC were detected in the patients. The most prevalent findings include eyelid changes, observed in 80.9% of the patients, and ocular surface changes as punctate keratopathy, occurring in 16 patients (76.2%), corneal neovascularization, and corneal opacities. Six patients (28.5%) presented corneoconjunctival tumor. More than half of patients had previous history of treatment of ocular neoplasia. Ocular burning was the most reported symptom. Conclusions. The ocular characteristics identified in this study corroborate the existing literature, mainly related to the surface. Concerning the XP variant and the gravity of ocular signs, XPC has earlier and more severe symptoms than XPV. Due to their relative rarity, publications of XP cases are important to understand the possible damages caused by the disease in the eyes and surrounding area.

Purpose: To identify the prevalence of the most common diseases diagnosed in the Low Vision Service (LVS) Methods: Seven hundred and thirteen patient’s clinical records were evaluated. The best corrected visual acuity (BCVA) in the better eye was collected. All of the diagnosed diseases related to visual impairment were identified and classified. A total of 220 patients (36.6%) fulfilled the concept of low vision (group 1), and 381 patients (63.39%) presented legal blindness (groups 2, 3, 4 and 5), according to the WHO Study Group on the Prevention of Blindness (Geneva, l972). Results: The most prevalent disorder was the group of Retinal Inherited Distrophies (n=124; 20.63%). Following the first group were Ocular toxoplasmosis with chorioretinal scars (118 cases, representing a prevalence of 19.63%), Myopic Maculopathy (38-6.32%), Age related Macular Degeneration (AMD) (36 cases, representing a prevalence of 6%). Conclusion: Planning and implementing preventive actions in ophthalmology requires appropriate comprehension about regional clinical problems. Social support, and a proper partnership between educational and health systems, are important to improve visual outcomes in patients diagnosed with low vision and legal blindness. Resumo Objetivo: identificar a prevalência dos distúrbios mais comuns em pacientes do Serviço de Visão Subnormal do Centro de Referência de Oftalmologia (CEROF - UFG). Método: Foram avaliados 713 registros de pacientes, t odos apresentavam erros refrativos corrigidos. Coletaram-se dois elementos: melhor acuidade visual corrigida (MAVC) no melhor olho e o diagnóstico da doença oftalmológica responsável pela deficiência visual. Todos os grupos etários foram incluídos, sem distinção entre sexo ou raça. Resultados: As doenças mais prevalentes foram distrofias retinianas hereditárias (124 pacientes; 20,63%), cicatrizes coriorretinianas por toxoplasmose (118-19,63%), maculopatia miópica (38-6,32%), Degeneração macular relacionada à idade (DMRI) (36-6%). 220 pacientes (36,6%) preencheram critério de baixa visão (grupo 1), e 381 (63,39%) apresentaram definição de cegueira legal (grupos 2, 3, 4 e 5) recomendada pelo Grupo de Estudos para a Prevenção da Cegueira WHO (Genebra, l972). Conclusão: Estudos nacionais mostram resultados semelhantes sobre cicatrizes coriorretinianas. Estudos epidemiológicos mostram maior prevalência de DMRI, provavelmente porque as clínicas oftalmológicas primárias falham no encaminhamento destes pacientes. A proporção de cegueira relacionada à ROP nos países desenvolvidos é maior, possivelmente porque não há plano de ação público oferecendo acompanhamento oftalmológico adequado para essas crianças. Não havia número significativo de pacientes com glaucoma congênito no departamento, o que pode se relacionar com as condições socioeconômicas e saúde no Brasil. Ações preventivas em oftalmologia necessitam de conhecimento científico de problemas oftalmológicos regionais aplicados à realidade, que será foco de tal ação. Um suporte social, incluindo parceria entre escola, família e sistema público de saúde, seria importante para gerar benefícios para a população.

Objetivou-se avaliar a melhora da acuidade visual (AV) antes e no 15° dia do pós-operatório de facectomia e o seu impacto na qualidade de vida dos idosos. Estudo prospectivo, desenvolvido com 156 pacientes submetidos à facectomia em campanha oftalmológica. De acordo com a tabela de Snellen, a AV média, em logMAR, após 15 dias da cirurgia melhorou de 1,23 para 0,57 nos idosos (p=0,000). Na comparação das médias de qualidade de vida, pelo questionário de avaliação da qualidade de vida Visual Functioning Questionnaire (VQF-25), o subdomínio visão geral apresentou a maior diferença entre as médias antes e após a facectomia (de 29,65 para 89,87). A análise de correlação apontou que a melhora da AV melhorou a satisfação geral, em relação à atividade para longe, dor ocular, saúde mental e dependência, levando a um impacto positivo na qualidade de vida dos idosos. Levantaram-se indicadores que direcionam à terapêutica mais individualizada.

This report presents multimodal imaging of a 27-year-old woman diagnosed with benign familial fleck retina (OMIM 228980), an uncommon disorder. Fundus photographs revealed retinal flecks that affected her post-equatorial retina but spared the macular area. Fundus autofluorescence and infrared imaging demonstrated a symmetrical pattern of yellow-white fleck lesions that affected both eyes. Her full-field electroretinogram and electrooculogram were normal. An optical coherence tomography B-scan was performed for both eyes, revealing increased thickness of the retinal pigmented epithelium leading to multiple small pigmented epithelium detachments. The outer retina remained intact in both eyes. Spectral-domain optical coherence tomography angiography with split-spectrum amplitude decorrelation algorithm and 3 × 3 mm structural en face optical coherence tomography did not show macular lesions. Benign familial fleck retina belongs to a heterogenous group of so-called flecked retina syndromes, and should be considered in patients with yellowish-white retinal lesions without involvement of the macula.

The purpose of the authors is to show clinical findings of a patient with benign concentric annular macular dystrophy, which is an unusual condition, and part of the “bull’s eye” maculopathy differential diagnosis. An ophthalmologic examination with color perception, fluorescein angiography, and ocular electrophysiology was performed.

In diabetic retinopathy (DR), macular involvement can present as either macular edema or ischemia. Fluorescein angiography remains the gold standard in the evaluation of retinal vascular perfusion and diagnosis of macular ischemia. However, it is a costly, time-consuming technique, it requires venipuncture, and reports of anaphylaxis and death related to fluorescein injections have been documented, despite their rarity. Optical coherence tomography (OCT) provides a fast and non-invasive method to assess retinal structures at a microscopic level. OCT angiography permits the noninvasive study of retinal and choroid circulation via motion contrast imaging. Split-spectrum amplitude decorrelation angiography combined with OCT angiography has furthered the understanding of retinal and choroidal vascular diseases, allowing the evaluation of retinal microvasculature and identification of subsequent disorders, including DR. Previous studies using OCT angiography have demonstrated that it may demonstrate DR findings such as microaneurysms, arteriolar wall staining, retinal neovascularization, and intraretinal microvascular abnormalities. The purpose of this article is to describe and discuss different concepts regarding OCT angiography, as well as its role in the diagnosis of DR and maculopathy.

Purpose. To compare fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) images of foveal avascular zone (FAZ) in patients with diabetic retinopathy (DR) with and without diabetic macular ischemia (DMI).Methods. The Wilcoxon signed-rank test was used to compare area measurements andpvalues of 2) and “small” (inferior to 0.32 mm2) groups. Quantitative analyses of the FAZ were performed using custom software.Results. Thirty-four eyes from 34 diabetic patients were enrolled. Subjects with DMI presented a mean area on FA and OCTA of 0.68 ± 0.53 mm2and 0.58 ± 0.35 mm2, respectively (p=0.1374). Patients without DMI presented a mean area on FA and OCTA of 0.19 ± 0.67 mm2and 0.20 ± 0.79 mm2, respectively (p=0.9594). The ICC for the FAZ measurements between the 2 observers on FA and OCTA was 0.96 and 0.92, respectively.Conclusion. OCTA represents a novel technique for the diagnosis of DMI and it may become an alternative to FA for this purpose.

Pseudophakic cystoid macular edema (PCME) is a common complication following cataract surgery. Although majority of patients with PCME remain asymptomatic, it remains an important cause of vision loss after cataract surgery. The pathogenesis of PCME remains unclear, but most authors agree that inflammation plays a major role in its development. There is no standard algorithm for treatment procedures for PCME. A biodegradable 0.7 mg dexamethasone intravitreal implant can be used to deliver medication into the posterior segment of eyes. This drug acts on all inflammatory mediators and has been approved for the treatment of macular abnormalities secondary to retinal vein occlusion and for non-infectious posterior uveitis. In this case series, we report six patients who presented with PCME and were treated with a 0.7 mg dexamethasone intravitreal implant. Favorable anatomical outcomes were demonstrated by spectral domain-optical coherence tomography images.

This study aimed to report the clinical and structural outcomes of intravitreal ocriplasmin in the treatment of vitreomacular interface disorders in two tertiary centers in Brazil. A retrospective study was performed by reviewing medical records and spectral domain optical coherence tomography (SD-OCT) findings of seven patients who were treated with a single ocriplasmin injection. A total of 57.14% of patients achieved resolution of vitreomacular traction as evidenced by SD-OCT. Regarding our functional results, 87.71% maintained or improved visual acuity after follow-up. To the best of our knowledge, this is the first study reporting initial results of ocriplasmin therapy in Brazil. RESUMO O objetivo desse estudo é relatar os resultados iniciais, tanto do ponto de vista funcional quanto anatômico, no tratamento das doenças da interface vítreo-macular com a ocriplasmina em 2 serviços terciários no Brasil. Um estudo retrospectivo foi realizado através de revisão de prontuários, além de análise de achados em tomografia de coerência óptica de domínio espectral (SD-OCT) em 7 pacientes tratados com uma única injeção intravítrea de ocriplasmina. Em nosso estudo 57,14% dos pacientes apresentaram resolução da tração vítreo-macular no SD-OCT. Em relação aos resultados funcionais, 87,71% dos pacientes mantiveram, ou melhoraram sua acuidade visual durante o acompanhamento. Para nosso conhecimento, trata-se do primeiro estudo em nosso país, mostrando resultados iniciais com ocriplasmina em pacientes tratados no Brasil.

Objective : The present study aimed to discuss the current management for dry and wet age-related macular degeneration (AMD). Emerging diagnostic and therapeutic options supported by the results of pivotal studies, different approaches such as “pro re nata (PRN)” and “treat-and-extend” protocols, and future trends have reshaped the AMD-treatment paradigm. Methods : This descriptive report provides a comprehensive analysis, focusing on the present “state of the art” literature, and also highlights some plausible pathways for future AMD treatment strategies. Results : The current understanding of the different angiogenesis and inflammatory mediators, including vascular endothelial growth factor, platelet-derived growth factor, and placental growth factor, has changed our understanding about AMD pathogenesis. This data has altered treatment options, aiming optimal results. Most of these pathways are still in the experimental stage, and may represent future alternatives, considering the chronic description of AMD. The antiangiogenic drugs remain the mainstay of AMD treatment, but recent trials, such as combination therapy, have revealed promising results. Optical coherence tomography advances also deserve special attention, since it is an important tool that is used on a regular basis for management of this condition. Conclusion : In spite of the significant advances in dry and wet AMD treatments, patients still require frequent injections and clinical appointments. Future trends have the potential to change this paradigm. AMD is a chronic disorder, and the consensus is that the best results will be accomplished with prompt detection and treatment, independent of the treatment strategy selected.

The development of photoreceptor replacement therapy for retinal degenerative disorders requires the identification of the optimal cell source and immunosuppressive regimen in a large animal model. Allotransplants are not acutely rejected in swine subretinal space, although it is not known if survival can be improved with immunosuppression. Here we investigated the survival and integration of expanded pig retinal progenitor cells (pRPCs) in normal recipients with and without transient anti-inflammatory suppression.pRPCs were derived from the neural retina of E60 GFP transgenic pigs, expanded for six passages, characterized, and transplanted into the subretinal space of 12 pigs. Six recipients received a single intravitreal injection of rapamycin and dexamethasone.pRPCs expressed the photoreceptor development genes Sox2, Pax6, Lhx2, Crx, Nrl, and Recoverin in vitro. Transplanted cells were identified in 9 out of 12 recipients 4 weeks after the injection. pRPCs integrated primarily into the photoreceptor inner segment layer and outer nuclear layer with single cells present in the inner nuclear layer. Donor cells remained recoverin-positive and acquired rhodopsin. We did not observe any signs of graft proliferation. The immunosuppression did not affect the survival or distribution of grafts. No macrophage infiltration or loss of retinal structure was observed in either group.Local immunosuppression with rapamycin and dexamethasone does not improve the outcome of pRPC allotransplantation into the subretinal space.Survival and integration of pRPC together with the lack of graft proliferation suggests that allogeneic RPC transplantation without transient immunosuppression is a favorable approach for photoreceptor cell replacement.