Kumar Atul, Midha Neha, Mohanty Sujata, Chohan Annu, Seth Tulika, Gogia Varun, Gupta Shikha
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India.
Stem Cell Facility, All India Institute of Medical Sciences, New Delhi 110029, India.
Int J Ophthalmol. 2017 Oct 18;10(10):1552-1558. doi: 10.18240/ijo.2017.10.12. eCollection 2017.
To evaluate the role of bone marrow-derived stem cells in the treatment of advanced dry age-related macular degeneration (AMD) using multifocal electroretinogram (mf-ERG) and fundus autofluorescence imaging.
Thirty patients (60 eyes) with bilateral central geographic atrophy (GA) were recruited. Worse eye of each patient received autologous bone marrow-derived hematopoietic stem cells (BM-HSCs) (group 1) and the fellow eye with better visual acuity served as control (group 2). The effect of stem cell therapy was determined in terms of visual acuity, amplitude and implicit time in mf-ERG and size of GA on fundus autofluorescence imaging. These tests were performed at presentation and first, third and sixth month follow up. Adverse events (if any) were also monitored.
At 6mo follow-up there was no statistically significant improvement in median logMAR best corrected visual acuity (BCVA) in either group. Mf-ERG revealed significant improvement in amplitude and implicit time in the intervention group. A significant decrease was also noted in greatest linear dimension (GLD) of GA in the eyes receiving stem cells [6.78±2.60 mm at baseline to 6.56±2.59 mm at 6mo (=0.021)]. However, no such improvement was noted in the control group.
Electrophysiological and anatomical improvement in the intervention group sheds light on the therapeutic role of BM-HSCs. Further studies are required to determine the stage of disease at which the maximal benefit can be achieved and to standardize the dose and frequency of stem cell injection.
使用多焦视网膜电图(mf-ERG)和眼底自发荧光成像评估骨髓源性干细胞在治疗晚期干性年龄相关性黄斑变性(AMD)中的作用。
招募30例双侧中心性地图样萎缩(GA)患者(60只眼)。每位患者较差的眼睛接受自体骨髓源性造血干细胞(BM-HSCs)治疗(第1组),视力较好的对侧眼作为对照(第2组)。根据视力、mf-ERG的振幅和隐含时间以及眼底自发荧光成像上GA的大小来确定干细胞治疗的效果。这些测试在就诊时以及随访的第1、3和6个月进行。还监测了不良事件(如有)。
在6个月的随访中,两组的中位logMAR最佳矫正视力(BCVA)均无统计学上的显著改善。mf-ERG显示干预组的振幅和隐含时间有显著改善。接受干细胞治疗的眼睛中GA的最大线性尺寸(GLD)也有显著减小[基线时为6.78±2.60 mm,6个月时为6.56±2.59 mm(P=0.021)]。然而,对照组未观察到此类改善。
干预组的电生理和解剖学改善揭示了BM-HSCs的治疗作用。需要进一步研究以确定能实现最大益处的疾病阶段,并规范干细胞注射的剂量和频率。