自体骨髓间充质干细胞移植治疗增生性糖尿病视网膜病变的安全性

Safety of autologous bone marrow mesenchymal stem cells transplantation in proliferative diabetic retinopathy patients

目的观察视网膜下间隙移植自体骨髓间充质干细胞(ABMSCs)治疗增生性糖尿病视网膜病变(PDR)的安全性。方法采用系列病例观察研究方法。于2014年3月至2015年12月纳入在陆军军医大学西南医院就诊并行视网膜下间隙移植ABMSCs的PDR患者4例4眼,其中男3例,女1例;平均年龄55岁;平均糖尿病病程10年,治疗前血糖均控制良好。所有入组患者进行常规眼科检查,术后1周、1个月、3个月、6个月、9个月、12个月进行视力、裂隙灯显微镜、彩色眼底照相、荧光素眼底血管造影(FFA)和光相干断层扫描(OCT)检查。结果所有患者在成功接受移植手术后均未出现任何全身及眼部不适。彩色眼底照相及OCT观察到移植的细胞存在于视网膜下间隙,并持续至移植术后1个月。FFA检查显示,后极部荧光素渗漏在术后1~3个月逐渐减轻,无灌注区范围无明显变化;1例术前伴有黄斑水肿患者FFA及OCT检查显示水肿逐渐消退,疗效持续至术后3个月。2例患者最佳矫正视力(BCVA)分别由术前的手动/眼前(0 ETDRS)和数指/50 cm(0 ETDRS)提高至术后的20/20(84 ETDRS)和20/200(38 ETDRS),2例患者在移植前后视力稳定在20/100。所有患者在术后第3个月行移植眼全视网膜光凝,后续按照常规玻璃体手术治疗DR处理,均无其他并发症发生。结论视网膜下间隙移植ABMSCs治疗PDR是安全的,移植细胞发挥了局部抗炎的作用,未发现细胞的增生反应及循环改善效果。

Objective To investigate the safety of autologous bone marrow mesenchymal stem cells(ABMSCs)transplantation into the subretinal space for the treatment of proliferative diabetic retinopathy(PDR).Methods The clinical data of four PDR patients(four eyes)who received ABMSCs transplantation into the subretinal space were collected in Army Medical University,Southwest Eye Hospital from March 2014 to December 2015,including 3 males and 1 female;the average age was 55 years old;the average course of diabetes was 10 years,and the blood glucoses were all well controlled before treatment.All the patients underwent conventional ophthalmologic examination,and visual acuity,slit lamp microscope,color fundus photography,fluorescein angiography(FFA)and optical coherence tomography(OCT)examination were performed at 1 week,1 month,3 months,6 months,9 months and 12 months after surgery.This study protocol was approved by Ethic Committee of Army Medical University,Southwest Eye Hospital(No.2013-34).Results Four patients diagnosed as PDR were enrolled in this study.All patients were performed ABMSC transplantation,and no one felt discomfort after treatment.FFA and OCT showed that the transplanted cells were present in the subretinal space until 1 month after transplantation.The macular edema of one patient diagnosed as macular edema preoperatively was relived gradually after transplantation,and the effects lasted 3 months after transplantation.The preoperative best corrected visual acuity(BCVA)of the two patients were improved from hand movement and finger counting to 20/20(84 ETDRS)and 20/200(38 ETDRS)after transplantation,respectively,and the visual acuities of the other two eyes were both stable.All patients underwent panretinal photocoagulatio 3 months after transplantation,and the follow-up treatment complied with the routine of post-vitrectomy for DR,no complications occurred during the follow-up period.Conclusions Subretinal transplantation of ABMSCs for PDR is safe.The transplanted cells show local anti-inflammatory effect,and no effect on cell proliferation or circulatory improvement are observed.