Mesenchymal stem and non-stem cell surgery, rescue, and regeneration in glaucomatous optic neuropathy

Abstract

Background Glaucomatous optic neuropathy (GON) is an anatomofunctional impairment of the optic nerve triggered by glaucoma. Recently, growth factors (GFs) have been shown to produce retinal neuroenhancement. The suprachoroidal autograft of mesenchymal stem cells (MSCs) by the Limoli retinal restoration technique (LRRT) has proven to achieve retinal neuroenhancement by producing GF directly into the choroidal space. This retrospectively registered clinical study investigated the visual function changes in patients with GON treated with LRRT. Methods Twenty-five patients (35 eyes) with GON in progressive disease conditions were included in the study. Each patient underwent a comprehensive ocular examination, including the analysis of best corrected visual acuity (BCVA) for far and near visus, sensitivity by Maia microperimetry, and the study of the spectral domain-optical coherence tomography (SD-OCT). The patients were divided into two groups: a control group, consisting of 21 eyes (average age 72.2 years, range 50–83), and an LRRT group, consisting of 14 eyes (average age 67.4, range 50–84). Results After 6 months, the BCVA, close-up visus, and microperimetric sensitivity significantly improved in the LRRT-treated group (p<0.05), whereas the mean increases were not statistically significant in controls (p>0.5). Conclusions Patients with GON treated with LRRT showed a significant increase in visual performance (VP) both in BCVA and sensitivity and an improvement of residual close-up visus, in the comparison between the LRRT results and the control group. Further studies will be needed to establish the actual significance of the reported findings.

Different Applications of Stem Cells Therapy for Degenerative Retinal Diseases

“…al conducted a study on 35 eyes of 25 patients suffering from glaucomatous optic neuropathy, where a control group included 21 eyes, while the LRRT group included 14 eyes, which were treated with suprachoroidal autograft of mesenchymal stem cells using Limoli Retinal Restoration Technique. Results after 6 months follow-up showed a significant increase in visual function, regarding BCVA, sensitivity and also close-up visus [85].…”

The Future of Stem Cells and Their Derivates in the Treatment of Glaucoma. A Critical Point of View

“…Each patient was subjected to a complete ocular examination: BCVA for far and near vision, sensitivity by microperimetry and spectral domain-optical coherence tomography (SD-OCT). At six months, in 21% of the patients with GON treated with LRRT, the disease had not progressed, and in 79% there was a significant increase in visual performance, as compared to the control group (matched GON patients according to the sensitivity alteration measured by microperimetry) [75]. This study stands out by its design, with noticeably clear and realistic inclusion and exclusion criteria (e.g., patients with systemic diseases such as multiple sclerosis, epilepsy, vasculitis, Parkinson's disease, renal and hepatic diseases, malignant neoplasms, and decompensated diabetes mellitus), characterization by flowcytometry of isolated stem cells and platelets and clinical and paraclinical follow-up.…”

“…However, it is worth noting that patients with glaucoma-induced optic nerve atrophy were not included in the reports of SCOT1-2 trials. Between 2015 and 2019, Limoli et al conducted a clinical trial that was registered at the Low Vision Center in Milan [75]. They injected adipose tissue derived MSCs as suprachoroidal autograft, using the Limoli retinal restoration technique (LRRT), in 35 eyes with glaucomatous optic neuropathy (GON).…”

“…The suprachoroidal area of only 25 mm 2 is a space between the sclera and choroid that circumferentially spans the entire posterior segment of the eye, and it has been shown to be a natural drug storage and an immune-protected region. From this space, growth factors secreted by stem cells can pass and reach the retina without producing immune reactions [75][76][77]. There are several methods to assess the SCS: surgical procedures, standard hypodermic needle, hollow microneedles.…”

Changes in best-corrected visual acuity in patients with dry age-related macular degeneration after stem cell transplantation: systematic review and meta-analysis

“…Findings from preclinical studies are encouraging, in particular, for mesenchymal cells. Some studies have examined repair processes associated with ganglion structures in glaucomatous opticopathy [ 19 – 22 ], and those associated with photoreceptor structures in Stargardt disease and dry AMD [ 23 , 24 ], as well as in retinitis pigmentosa (RP). Cell therapy or cell-mediated therapy may be defined as any therapeutic modality based on the use of cell transplants or grafts that aims to neuro-enhance compromised cells, supporting repair or regeneration, including replacement, of receptors, mitochondrial components, and connecting fibres, while integrating with the remaining retinal structures [ 25 , 26 ].…”