The progress in the treatment of Retinal pigment degeneration
By Drs. Like Wu, Xiaojuan Wang, Bo Cheng
Wu Medical Center, Bejing, China
The retina is a layer of thin hyaline tissue all of the visual information is transferred to the central nervous system by the nerve cells (cones and rods) in the retina in other words, it's extension part of the central nervous system.
The causes of pathological changes: the most common cause is Ischemic retinopathy, outbreak visual loss in single eye should be highly suspected of ischemia retinae. Retinal detachment, macular degeneration, glaucoma and vitreous hemorrhage are causes of retinopathy. The following will mainly explain retinosis.
Retinosis
Retinosis is one of the main causes of chronic decreased visual acuity, in general it includes membrane degeneration and macular degeneration. There are several types which are probably related to other nervous system disease.
Macular degeneration is the main cause of visual loss in elderly people, gradually there is a decrease of central visual acuity, which affects reading, the patient retains the peripheral vision and can still walk.
In young and middle-aged people, the most common disease is a kind of hereditary diseases in the external light layer and the adjacent pigment epithelium, named retinitis pigmentosa (RP). Clinically the contraction of the visual field, central vision relative preservation (tube type field) metamorphopsia (visual distortion), poor adaptation to the dark and night blindness are characteristics of this disease.
Teen-agers retinal degeneration a kind of staged degeneration disease mostly seen in teen-agers which main pathological change is large areas of central retinal lesions it can result in progressive spastic paraplegia or ataxia.
In infants and young children, some Lysosomal diseases called macular degeneration. This is characterized by protein which cannot be degraded and polysaccharide gathering in the brain, optic nerve, macular and retina.
Retinosis is also can seen in oat-cell carcinoma patients, those patients blood serum have antibodies against retinal ganglion cells.
These are a kind of progressive vision loss, night blindness contraction of visual field, fundus pigmentation hereditary, gene mutation and immune injury of eye disease. Commonly seen in heredopathia, modes of inheritance are Autosomal dominant, recessive or X-linked recessive inheritance, most involve both eyes, a single eye being involved and Quadrant are rare. The disease progresses slowly, with an unfavourable prognosis. The younger the age of onset, the more serious, the earlier blindness happens. The older the age of onset, the later blindness happens.
Pathological change:
The main change is degeneration in the stratum neuroepitheliale retinae, especially in the rod cells, than the retina gradually atrophies from the inside to the outside, with gliosis.
Degeneration and hyperplasia occurs in the pigment epithelial cell can find cases of depigmentation or accumulation moving to the entorretina. Glassy degeneration and thickening in the retinal vascular wall, can even entirely shut in the lumen. Different degrees of hardening in the choroidal vessels, results in the blood capillary completely or partially disappearing. The optic nerve may complete atrophy, gliosis in discus opticus which becomes a membrane, connects with the gliosis in the retina.
Clinical manifestation:
1. Night blindness and progressive visual loss.
2. Visual field progressive concentric contraction to tubular visual field.
3. Optic fundus: pale, sallow, retinal vascular narrow, fundus gray cyan contamination, osteoblast pigmentation, obvious in ambitus, atrophy of the retina, can see sclerotic chorioid. 4. Fluorescence fundus angiography: transmitted fluorescence in early stage, arterial filling slowly, macula lutea may have leakage because cystoid macular edema.
5. ERG: extinguished type.
Treatment:
Traditional treatment can not stop degeneration and necrosis in retinal nerve cells and pigment cells. There has been no effective treatment before. In recent years, through more than ten years treatment experience, Wu Medical Center (WMC) found that stem cells can have a good treatment outcome in Retinosis. Stem cell treatment can effectively slow down or stop the disease progressing. The molecular chaperones from stem cells can clear a part of abnormal accumulation protein, can slow down or stop the disease progress. And immunoregulation from stem cells can resist the antibody which causes damage in the retina and optic nerve. The nerve cells differentiated from nerve stem cells can increase the number of retinal neural photoreceptor cells and improve dark adaptation ability, then can increase the eye sight and expand the visual field of the patients.
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