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Eye Disorders

Author Admin Views Posted at 2013/12/29

The progress in the treatment of hypopsia caused by Retinal pigment degeneration, macular degeneration and atrophy of the optic nerve.

1. Retinal abnormality

By Drs.Like Wu, Xiaojuan Wang and 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. 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 stem cells medical center (WSCMC) 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 cell which is differentiated from nerve stem cells can repair part of the damage and the vitium, then can increase the eye sight and expand the visual field of the patient.

 2. Clinical Advances of Stem Cell Treatment for Macula Degeneration

By Drs.Like Wu, Xiaojuan Wang, Bo Cheng, Susan Chu, Mary Zhang and Fang Peng

Wu Medical Center, Bejing, China

Macula lutea  is located in the rear area of the eyes. It is a very important area of the eyes where photo receptor cells exist.  The main function of the macula is central vision, to distinguish the small things and for color.  A person's daily life activities such as reading, driving and  facial recognition depend on the intact macula function (please see the anatomy). If we take the human eyes as a camera, the macula lutea would be the central sensitive exposure area, like camera film. In general, the macula collect the imaging stimulation from the central visual field and send signals to the occipital lobe cortex of the brain via the optic nerve pathway to build the visual information. Once the macula area has a deficit, then the normal imaging information can not be collected successfully. Maybe it will not affect the visual ability very much at an early stage, but with the further progression of  macula degeneration, the patient will have symptoms of central vision loss, blurred vision, black shadows,  metamorphopsia etc. It can even lead to  complete central vision loss with further deterioration. Macula degeneration has been recognized as the main type of disease which can lead to blindness. Till now, there has been no cure for macula degeneration in the world. 
 
The main reason for macula degeneration is still not very clear, most doctors believe it is the result of hereditary factors and environmental factors. The most important risk factor is age and the chances of contracting it rises with  increasing age. Macula degeneration mainly occurs in people more than 55 years old. Other factors which relate to macula degeneration are:
1. Hereditary factors: A patient's chance of suffering from MD will increase if there are MD patients among their family members. 2. Ethnicity: Tests have shown that the MD rate of Caucasians is higher than others. 3. Smoking: The proportional MD rate of smokers is twice that of non-smoking people.

The age-related MD is characterized by chronic macula degeneration changes. In general, it has been divided into dry (atrophy) and wet (exudation) macula degeneration. There are more than 85-90% of cases that belong to dry macula degeneration, and the wet MD only had 10-15%.  Stargardt’s disease is a  special type of MD which mainly happens in teenagers and it is an autosomal recessive inheritance disease.

The disease usually combines with retinal degeneration or dystrophy in the last stage, and that will affect the neuroepithelial cells and RPE cells which accelerates the visual ability decline. The cone cells and rod cells become damaged and lose their normal function and those cells cannot be regenerated. Doctors had not been able to find an efficient method to prevent the visual ability loss and the degenerative change  because those damaged cells could not be regenerated. The disease would progress gradually and the damaged area would spread. With the development of regenerative medicine technology, doctors in Wu Medical Center applied 2 kinds of stem cells to treat the MD patients and achieved very satisfactory clinical outcomes. The neural stem cells can evolve into healthy optic nerve cells and the mesenchymal stem cells can change into functional RPE cells via our  elaborate cell regulation control. The implanted stem cells can supplement the amount of functional optic neurons and cells within the retina and macula area of those MD patients. This will prevent the degenerative nature of the disease effectively. The treatment restores part of the patient's eyesight  and their life quality improves as a result.

From many years of clinical treatment and research, Wu Medical Center now owns a systematic and effective treatment method to deal with macula degeneration.  We work on replacement of the photoreceptor cells in the macula area including the cone cells and rod cells. The repair of RPE cells and necessary clinical support technology such as improving the choroidal vessels blood circulation  helps the new cells survive and work. The cells target the macula area, restart and activate the new photoreceptor cells function, etc. From the clinical data,  a patient's visual ability showed good improvement and the development of the disease had been  effectively prevented. It is a new technology which is a  breakthrough that has overturned the previous concept that  macula degeneration can not be treated.

3. Optic Neuropathy (Atrophy)

By Drs. Like Wu, Xiaojuan Wang and Bo Cheng

Wu Medical Center, Bejing, China

Optic neuropathy refers to damage to the optic nerve due to any cause. Damage and death of these nerve cells, or neurons, leads to characteristic features of optic neuropathy. The main symptoms are loss of vision, field of vision centripetal narrowed, vision defect, hemianopsia, with colors appearing subtly washed out in the affected eye. On medical examination, the optic nerve head can be visualized by an ophthalmoscope. A pale disc is characteristic of long-standing optic neuropathy. In many cases, only one eye is affected and patients may not be aware of the loss of color vision until the doctor asks them to cover the healthy eye.

Optic neuropathy is often called optic atrophy, to describe the loss of some or most of the fibers of the optic nerve. In short, optic atrophy is the end result of any disease that damages nerve cells anywhere between the retinal ganglion cells and the lateral geniculate body (anterior visual system).

Causes

The optic neuropathy may be caused by any of the following:

• Ischemic optic neuropathy

• Optic neuritis

• Compressive optic neuropathy

• Infiltrative optic neuropathy

• Infiltrative optic neuropathy

• Traumatic optic neuropathy

• Mitochondrial optic neuropathies

• Nutritional optic neuropathies

• Toxic optic neuropathies

• Hereditary optic neuropathies

Treatment

As far as the treatment for optic nerve atrophy is concerned, we should first consider the incentives and then apply the treatment accordingly. For instance, for patients suffering optic nerve atrophy caused by pituitary tumor, they should undergo surgery to cut the tumor out. Optic canal fracture patients should receive treatment to remove the fracture and to release optic canal and the front end of dural sheath´s middle part with decompression. Optic nerve inflammation patients should take some measures to resist inflammation and do some immune-regulation work. Once the patient develops optic nerve atrophy, it is almost impossible for him or her to heal. The purpose of early treatment is primarily to protect the remaining optic nerve cells and nerve fibers, and to maintain or even restore part of these cells´function.

However, previous treatment provides no effective way to treat sequela of optic nerve atrophy. There is no way to regenerate the lost optic nerve cells and nerve fibers.

In recent years, using stem cells technology (nerve regeneration technology) we have treated many patients who suffered from optic neuropathy or optic nerve atrophy. Almost all of them have had varying degrees of improvement after receiving treatment.

Neural stem cells are a kind of special cell. With certain positioning and adjusting technology, they will be localized to the accurate lesion part in visual photoreceptor cells, retina and optic nerve. After being positioned in the lesion part, they will differentiate into functional optic neurons, oligodendrocytes and astrocytes, which will increase the number and restoration of optic nerve cells as well as the optic nerve´s regulation toward retina and visual photoreceptor cells.

The mesenchymal stem cells can differentiate into photoreceptor cells and immune-adjustment cells. The differentiated cells will first repair patients´ autologous cells´synaptic nucleoprotein, and eventually play a positive role in treating lesion in retinal pigment cells and optic nerves.

For patients who suffer from optic nerve injuries or optic nerve atrophy, such a treatment will effectively supplement the missing optic nerve cells and increase the restoration of fibers, and eventually achieve the goal of improving patients´eyesight, field of vision and ability of color discrimination.

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