Mills J O, Jalil A, Stanga P E
Manchester Royal Eye Hospital, Manchester, UK.
Manchester Vision Regeneration (MVR) Lab at Manchester Royal Eye Hospital, NIHR/ Wellcome Trust Manchester CRF, Manchester Royal Eye Hospital, Manchester, UK.
Eye (Lond). 2017 Oct;31(10):1383-1398. doi: 10.1038/eye.2017.65. Epub 2017 May 26.
Retinitis pigmentosa and age-related macular degeneration are two significant causes of severe visual dysfunction. In both, the retinal photoreceptors degenerate, preventing successful conversion of light into electrical energy that is interpreted in the visual cortex as visual function. Artificial vision or visual function began over two centuries ago with the idea of creating artificial light pulses, or phosphenes, through cortical stimulation. The pursuit is now on to improve artificial visual function. Two retinal implants appear the most likely to succeed in the future having undergone multicentre human trials: the Argus II electronic epiretinal device (Second Sight Medical Products, CA, USA) and Alpha-IMS electronic subretinal device (Retina Implant AG, Germany). The trial results to date are encouraging with visual improvement and acceptable safety profiles reported for both devices. At present, the visual function generated by either device does not offer high enough resolution or acuity for a patient to regain a fully functional life. Despite this, both devices not only have the potential, but have actually improved the vision-related quality of life in a significant number of patients implanted. With this in mind, the economic argument is clear. Provided device-life is long enough, its cost should be acceptable for the obtained improvement in the quality of life. The aim of this Review Article is to assist those readers that may be considering offering any of these devices as a treatment for blindness in Retinitis Pigmentosa.
视网膜色素变性和年龄相关性黄斑变性是导致严重视觉功能障碍的两个重要原因。在这两种疾病中，视网膜光感受器都会退化，从而无法成功地将光转化为电能，而这种电能在视觉皮层中被解读为视觉功能。人工视觉或视觉功能的研究始于两个多世纪前，当时的想法是通过皮层刺激产生人工光脉冲，即光幻视。目前人们正在努力改进人工视觉功能。两种视网膜植入物在经过多中心人体试验后，似乎最有可能在未来取得成功：阿格斯II型电子视网膜装置（美国加利福尼亚州的Second Sight Medical Products公司）和Alpha-IMS电子视网膜下装置（德国的Retina Implant AG公司）。迄今为止的试验结果令人鼓舞，两种装置均报告了视觉改善情况和可接受的安全性。目前，这两种装置所产生的视觉功能的分辨率或敏锐度都不够高，无法让患者重新过上完全正常的生活。尽管如此，这两种装置不仅具有潜力，而且实际上已经显著改善了大量植入患者与视力相关的生活质量。考虑到这一点，经济方面的理由很明确。只要装置寿命足够长，其成本对于所获得的生活质量改善来说应该是可以接受的。这篇综述文章的目的是帮助那些可能正在考虑提供这些装置来治疗视网膜色素变性导致的失明的读者。
