Intravitreal Injections of Cord Blood Platelet-Rich Plasma in Dry Age-Related Macular Degeneration: Regenerative Therapy

Purpose: Intravitreal injections (IVIs) of umbilical cord blood platelet-rich plasma (CB-PRP) were investigated to assess their safety and efficacy in slowing the progression of atrophy in eyes with late-stage dry age-related macular degeneration (AMD).\r\nDesign: Subjects: Methods:\r\nRandomized, controlled, prospective study.\r\nPatients with AMD aged >65 years and diagnosed with bilateral geographic atrophy were enrolled. One eye of each subject received the treatment of intravitreal CB-PRP 0.05 ml, while the fellow eye\r\nreceived a sham injection. Atrophic areas were identified as large choroidal hypertransmission defects (hyperTDs) on en face subretinal pigment epithelium slabs (64e400 mm beneath Bruch’s membrane) obtained 0.321 from swept-source OCT angiography scans. The main outcome was the mean annualized growth rate of the square root transformed area measurements in both treated and nontreated eyes.\r\nMain Outcome Measures: The mean  standard deviation (SD) square root hyperTD area in the treated eyes was 3.30  0.99 mm at baseline and 3.49  0.98 mm after CB-PRP (IVI). In nontreated eyes, the mean square root hyperTD area was 2.96  0.94 mm at baseline and 3.18  0.94 mm after sham injections.\r\nResults: Twenty-six eyes of 13 patients were included. In treated eyes, the mean  SD best-corrected visual acuity (BCVA) was 48.92  16.33 letters at baseline and 51.46  12.27 letters at last follow-up. In untreated eyes, BCVA was 67.69  10.89 letters at baseline and 65.38  10.34 letters at last follow-up. The mean follow-up was 258.46  97.54 days. In both groups, no statistically significant difference was observed between the baseline and final BCVA. For treated eyes, the mean annualized growth rate (square root) was 0.275 mm and for nontreated eyes it was 0.321 mm. The annualized growth rate of the hyperTDs in treated eyes was 14.5% lower than that in nontreated eyes (P 1⁄4 0.007). No adverse events were recorded.\r\nConclusions: These preliminary data suggest that intravitreal CB-PRP injections might be safe and effective in slowing the progression of atrophy in AMD. Extended follow-up and larger sample sizes are needed to confirm our findings and determine the optimal treatment regimen for this novel treatment option in late-stage dry AMD.