Intravitreal injection of antiangiogenic agents is widely used to treat retinal vascular disease. This therapy can induce regression of neovascular vessels; reduce intraocular inflammation and retinal vascular permeability, and control macular edema. However the action period of these agents is short, and thus this therapy need repeated injections which cause higher operation risk and cost. Retinal laser photocoagulation therapy can close retinal capillary non-perfusion area and neovascular vessels, reduce macular edema caused by vascular leakage. However, as its therapeutic effect is based on the destruction of the retinal tissues in the lesion area, this therapy need longer time to show its effects. When the disease is controlled by this method, it may already induce some structural irreversible damages to the retina, especially the macular. This is why the visual acuity is not satisfactory in some patients, even though the disease get controlled, macular edema gets disappeared and anatomical structure of retina get improved. Properly evaluating all the pros and cons of retinal photocoagulation and intravitreal injection of antiangiogenic agents, will allow us to explore a better way to combine these two therapies to treat retinal vascular diseases.
Objective To observe the effects of subretinal transplantation of rat mesenchymal stem cells (rMSCs) on Sodium Iodate (SI)induced retinal degeneration. Methods One hundred and twenty BrownNorway (BN) rats were divided into three groups including SI injection group,rMSCs transplantation group and normal control group, each with 40 rats. The retinal degeneration was induced by caudal vein injection of SI. The retinal pigment epithelium（RPE）and neural retinal were evaluated by ocular fundus photograph, fluorescein fundus angiography (FFA)，electroretinogram (ERG) and histological approach, and TUNEL（terminal deoxynucleotidyl transferasemediated dUTP nick end labeling ）. CMDiIprelabeled primary rMSCs were transplanted into the subretinal space of SIinduced rats. The survival, integration, and differentiation of rMSCs were observed between 14 day to 60 day after the transplantation.Results The rat retinal function was gradually reduced after14 days of SI injection, with a timedependent manner. After the RPE cells were damaged，the outer segments of photoreceptors became disrupted and shortened until karyopyknosis. The nuclear morphology and positive TUNEL labeling indicated that the death of photoreceptor cells was apoptosis. After rMSCs transplantation, CMDiI labeled donor cells were observed to be scattered in the subretinal space and expressed RPE cell markers. Average amplitude of b wave and Ops (oscillation potential) in ERG improved 27.80%,59.38% respectively after rMSCs transplantation.Conclusions Transplanted rMSCs can survive in subretinal space and differentiate into RPE.
Replacement therapy of stem cells transplantation represents a potential treatment for neural retinal diseases. Despite the encouraging results in laboratory, the clinical application of cells replacement therapy is still difficult because the limitation of seed cells, immunologic rejection, oncogenicity and ethical problems, etc. Recent breakthrough in somatic reprogramming provides a promising solution overcoming these obstacles. Further researches on virus free reprogramming will make the clinical application of stem cell replacement therapy possible.
Objective To observe the clinical manifestation and treatment effect of Coatsprime; disease in adulthood. Methods The clinical data of 18 adult patients with Coatsprime; disease from 1980 to 2006 at the department of ophthalmology, Peking Union Medical College Hospital which had been diagnosed by ocular fundus examination and fundus fluorescein angiography (FFA), were retrospectively analyzed. The follow-up period was one year. Coatsprime; response diseases in all the patiens were excluded, such as history of radiation therapy, intraocular inflammation, retinal vascular occlusion, age-related macular degeneration (AMD) and more leakage of diabetic retinopathy. The patients, 14 males and 4 females, 11 left eyes and 7 right eyes, all of them occurs in unilateral; aged from 37 to 55 years with the average age of 43 years; the initial diagnostic vision was 0.02 to 1.5, the visual value was 0.1. 17 patients (17 eyes) were treated by laser photocoagulation, 1 patient was treated by release of retinal operation with condensation. The mean follow up period was 3.7 years (ranged from 1 to 15.3 years). Results In 18 patients (18 eyes), vitreous clear in 14 eyes, vitreous few muddy in 4 years when initial diagnosis. The optic discs in 18 eyes are normal. Lesions confined to one or two quadrant, for the most are in the temporal(15/18 eyes), less are in Bice (4/18 eyes), only one eye at top; two eyes lesions involved in 2 quadrant. There are typical retinal vascular anomalies expansion, miliary aneurysm, arterial aneurysm, macroaneurysms and capillary without perfusion areas; yellowwhite hard leakage by a large block or cluster in Lesion corresponding region. More than half of the eyes with macular edema or leakage; limited retinal detachment in 4 eyes, the range was very wide in 1 eye; retinal hemorrhage in 3 eyes. After treatment the exudation or the hemorrhage were absorbed and retinas were reset. Compared the visual acuity with before treatment, mostly (64.3%) improved 2 lines or keep in 1.2-1.5, no one decreased over 2 lines. The last vision was 0.02-1.5, the visual value was 0.1. Conclusions Coatsprime; disease in adulthood diagnosed in first time has similar characteristics with children, such as vascular anomaly of retina, fundus exudation. The differences including limited area of involvement, less hemorrhages, mild damage on macular, slow development of lesions in follow-up period and better visual prognosis. （Chin J Ocul Fundus Dis，2008，24：279-282）