Medical Updates
This article report was on July 2009
by Dr. Wendy Wang, Dr. Like Wu and Dr. Xiaojuan Wang
The patient is a 41-year-old female; both eyes were presented with progressive impaired vision for the past 20 years. She was diagnosed with retinitis pigmentosa disease.
Medical History: No signs of hepatitis, tuberculosis, trauma, no blood transfusions, and no history of smoking, alcohol or drug abuse. No known allergies to medications.
Admission PE:
Internal Medicine Examination: Normal.
Neural System Examination:
She was alert and her speech was clear. Her memory, calculation and orientation ability were all normal. Her bilateral pupils were equal in size and round, with a diameter of about 3.0mm. Bilateral direct light reflex and indirect light reflex were sensitive. Loss of central binocular vision field. She has problems seeing clearly with her peripheral vision and can only distinguish between large objects. She could not accurately identify the number of fingers. Chromatic vision was poor, could not distinguish between certain colors such as black, green, pink, and purple.
Ophthalmoscope Examination:
We discovered bone cell type contour melanin in the retina ambitus, the retina arteriostenosis and optic nerve head assumed a yellowish color, the eyeballs could move flexibly and there were no obvious signs of nystagmus. The volume grain was symmetrical in the tongue, no grooves in between. Both arms and legs have myodynamia, muscular tone was normal, tendon reflexes of all four limbs are normal. Pathology was negative.
Assistant Examination:
Routine Blood Test: hepato-renal function, electrolyte, hemoglutination, homocystein were all normal. Thyroid gland function five items: FT311.90pmol/L, FT424.70pmol/L, others were normal. Hepatitis antibody, syphilis antibody and AIDS specificity antibody were negative.
Diagnosis: Retinitis pigmentosa
Treatment Procedure and Results:
The patient received four implantations of stem cells, as well as the self stem cells activation treatment. The patient received treatment to improve blood circulation and to increase the blood supply to the damaged nerves and to nourish the neurons. After the treatment, the patient's condition had good improvement, gradually: After the treatment new blood vessels have formed in the eyes, and the color of the retina in the left eyeball has improved slightly. The yellow spot is clearer than before. The binocular vision has improvement, the central vision field can distinguish between the shapes of individual objects, but the clarity is still not good. She can accurately identify the number of fingers shown to her; her peripheral vision has improved and she can distinguish between different body types and hairstyles much more easily. Her chromatic sensation is more sensitive and she has increased sensitivity to blue, red and yellow.
Case Analysis:
According to the patient's explicit medical history, and eye examination, her binocular center vision field was lost, peripheral vision was poor, and was diagnosed with retinitis pigmentosa. Retinitis pigmentosa (RP) is a group of genetic eye conditions and is caused by a degeneration of the retina's light receptor cells and the pigment epithelium cells. It's progressive, hereditary, and attributed to malnutrition and genetic regression of lesions. Up until now, there was still no special therapy for retinitis pigmentosa. At present, the main method of treatment is divided into: pharmacological treatments (including neurotrophic factors), transplantation of the retina, biotherapy (including gene therapy, cell treatment) and so on. It is widely believed that gene therapy is the most ideal method for treating retinitis pigmentosa. But RP has genetic heterogeneity and pleiotropy, therefore the relationship between the genetic changes and the clinical manifestations of retinitis pigmentosa are complex. At present doctors have difficulty fully understanding this relationship, and it is difficult to find a starting point with gene therapy. The retina transplant technology is not mature, therefore serious complications can result and the curative effect is also inaccurate. Biological treatment, specifically nerve stem cell treatment, has opened a new way for the treatment of retinitis pigmentosa. We used nerve stem cells to treat this particular patient and received positive results. Nerve stem cell treatment can delay the development of the disease, reduced or block the degeneration of the vision cells and retinal pigment epithelium cells then increase the patient's vision and improve the patient's quality of life.
The mechanisms of stem cell treatment for retinitis pigmentosa include:
1. The stem cells have proliferative and multi-directional differentiation ability. They can migrate to the area of neurotrosis and then multiply and split up and repair some of the damage to the retinal pigment epithelium cells.
2. The stem cells can secrete many kinds of neurotrophic factors to help repair the damage to the retinal pigment epithelium cells.
3. The function of the implanted nerve stem cells is to make up for the impaired cell's partial flaws or to inhibit the impaired cell's unusual functioning. We have successfully used stem cell treatment for eleven patients suffering from retinitis pigmentosa and eight people made remarkable progress, significantly improving their visual acuity and as a result, improving their daily lives as well.
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