Management of Retinitis Pigmentosa via Platelet-Rich Plasma or Combination with Electromagnetic Stimulation: Retrospective Analysis of 1-Year Results.

PURPOSE: To investigate whether the natural progression rate of retinitis pigmentosa can be decreased by subtenon autologous platelet-rich plasma application alone or combination with retinal electromagnetic stimulation. METHODS: The study includes retrospective analysis of 60 patients with retinitis pigmentosa. Patients constitute three groups with similar demographic characteristics: the combined management group (group 1) consists of 20 patients with retinitis pigmentosa (40 eyes) who received combined retinal electromagnetic stimulation and subtenon platelet-rich plasma; the subtenon platelet-rich plasma-only group (group 2) consisted of 20 patients with retinitis pigmentosa (40 eyes); the natural course (control) group (group 3) consists of 20 patients with retinitis pigmentosa (40 eyes) who did not receive any treatment. Horizontal and vertical ellipsoid zone width, fundus perimetry deviation index, and best corrected visual acuity changes were compared within and between groups after a 1-year follow-up period. RESULTS: Detected horizontal ellipsoid zone percentage changes were + 1% in group 1, - 2.85% in group 2, and - 9.36% in group 3 (Δp 1 > 2 > 3). Detected vertical ellipsoid zone percentage changes were + 0.34% in group 1, - 3.05% in group 2, and - 9.09% in group 3 (Δp 1 > 2 > 3). Detected fundus perimetry deviation index percentage changes were + 0.05% in group 1, - 2.68% in group 2, and - 8.78% in group 3 (Δp 1 > 2 > 3). CONCLUSION: Platelet-rich plasma is a good source of growth factors, but its half-life is 4-6 months. Subtenon autologous platelet-rich plasma might more effectively slow down photoreceptor loss when repeated as booster injections and combined with retinal electromagnetic stimulation. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT04252534.

Management of Deep Retinal Capillary Ischemia by Electromagnetic Stimulation and Platelet-Rich Plasma: Preliminary Clinical Results.

INTRODUCTION: To investigate the efficacy of retinal electromagnetic stimulation and sub-tenon autologous platelet-rich plasma in the treatment of deep retinal capillary ischemia. METHODS: The study included 28 eyes of 17 patients aged 15-76 years (mean 37.9 years) who had deep retinal capillary ischemia. Patients who had acute-onset paracentral scotoma in the last 1 month were included in the study between January 2018 and January 2019. The diagnosis of deep retinal capillary ischemia was based on clinical history and typical findings of optical coherence tomography angiography. The eyes were divided into three groups: group 1 (n = 7 eyes) received electromagnetic stimulation alone; group 2 (n = 7 eyes) received electromagnetic stimulation and sub-tenon autologous platelet-rich plasma injection; group 3 had no intervention and served as a control group (n = 14 eyes). The patients underwent ten sessions of electromagnetic stimulation in groups 1 and 2. Sub-tenon autologous platelet-rich plasma injection was performed immediately after the first, fifth, and tenth sessions of electromagnetic stimulation in group 2. The deep retinal capillary density and best corrected visual acuity changes were investigated before and after treatment at the first month. RESULTS: The mean deep retinal capillary density was 52.0% before electromagnetic stimulation and 56.1% after ten sessions of application in group 1; this improvement was statistically significant (p = 0.01). In the combined treatment group (group 2), the mean deep retinal capillary density was 46.9% before the treatment and 56.5% after the treatment; this increase was also statistically significant (p = 0.01). Statistically significant best corrected visual acuity improvement (p = 0.01) could be achieved only in group 2. The combined treatment was significantly superior (p < 0.01) to treatment with only electromagnetic stimulation regarding best corrected visual acuity and deep retinal capillary density. In the control group (group 3), there was no statistically significant change (p = 0.09) in the mean deep retinal capillary density and best corrected visual acuity. CONCLUSION: Treatment of the underlying cause is a priority in the treatment of deep retinal capillary ischemia. However, in the acute period, local ischemia treatment is necessary to prevent permanent retinal damage and scotomas. In mild cases, only electromagnetic stimulation, which is non-invasive and easy to use, might have a beneficial effect on deep retinal capillary density. In more severe cases, sub-tenon fresh autologous platelet-rich plasma injection together with electromagnetic stimulation may be more effective in the treatment of local ischemia of the retina in order to augment the response. FUNDING: The Rapid Service Fees were funded by the Ankara University Tecnopolis Institute. CLINICAL TRIAL REGISTRATION: titck.gov.tr identifier, 2018-136.

The effect of age and cataract surgery on macular pigment optic density: a cross-sectional, comparative study.

BACKGROUND: To analyze the effects of age, cataract surgery and postoperative period on macular pigment optical density (MPOD). METHODS: The study included cases referred to Ankara University Department of Ophthalmology, between April and June 2012, who had a transparent natural lens or had undergone cataract surgery at least a year ago with their best corrected visual acuity of ≥ 0.5 based on Snellen chart. Presence of an ocular disease that might affect lens, retina and optic nerve (cataract, macular degeneration, diabetic retinopathy, glaucoma etc.), cataract surgery within the previous year, light-colored iris, smoking and use of micronutrition supplementation were determined as exclusion criteria. After detailed opthalmologic examination of all patients, they were divided into three groups based on their age and their lens status as: group 1, patients < 50 years of age having a clear lens; group 2, patients > 50 years of age having a clear lens; and group 3, patients > 50 years of age who had cataract surgery. Age, gender, and postoperative period of the patients as well as the MPOD values of the eyes measured with heterochromatic flicker photometric (HFP) method (MacularMetricsTM) were included in the analysis. RESULTS: Sixty-eight eyes of 37 cases with a mean age of 53.4 ± 15.3 years were enrolled in the study. Group 1 included 20 eyes of 10 cases (mean age 29.4 ± 9.5); group 2 included 32 eyes of 16 cases (mean age 60.3 ± 6.8); and group 3 included 16 eyes of 11 cases (mean age 65.2 ± 9.7). The mean macular pigment optical density value of all cases was 0.511 ± 0.192 log unit, while the mean MPOD values of groups 1, 2 and 3 were 0.570 ± 170, 0.528 ± 203 and 0.400 ± 180 log units, respectively. The mean MPOD values of the patients with clear lens aged < 50 and aged > 50 years did not reveal a statisticially significant difference (p = 1). However, the mean MPOD value of the cataract surgery group (group 3) was found to be statistically significantly lower than the group 1 and group 2 (p = 0.022, p = 0.039, respectively). The correlations between MPOD values and postoperative periods of the patients in group 3 showed that a decrease in MPOD values in parallel with duration of the postoperative period and this negative correlation was found to be statistically significant (r: -0.66, p = 0.005). CONCLUSION: Our study has demonstrated that a significant correlation does not exist between age of the patients and MPOD values. MPOD values were lower than age-matched patients who had undergone cataract surgery and finally an inverse correlation existed between duration of the postoperative period after cataract surgery and MPOD values.