Tuesday, March 31, 2009

Stem cell treatment of Macular Degeneration

Below is an article from the xCell Center's website http://www.xcell-center.com/treatments/diseases-treated/macular-degeneration.aspx. In case you didn't know, Ocular Histoplasmosis Syndrome (OHS) is very similar to Wet Age-Related Macular Degeneration (AMD). AMD typically impacts people 55 and older, but AMD & OHS are treated the same b/c its the same thing happening in both cases ... just for different reasons. 

New treatments involving the retina are typically conducted on AMD patients b/c their condition can be proven. OHS is very hard, if not impossible, to prove b/c the fungus is not present ... OHS patients wait for testing to be done on AMD patients, and then we undergo the same procedures and typically get the same results. Unfortunatley, its usually not covered by our insurance as they like to see factual proof of a condition. Regardless, this break through in stem cell research is a very big step forward for both AMD and OHS patients.

The article: 

Macular degeneration is a retinal degenerative disease that causes progressive loss of central vision. The risk of developing Macular degeneration increases with age. The disease most often affects people in their sixties and seventies. Macular degeneration is the most common cause of vision loss in individuals over the age of fifty.

The macula is the central portion of the retina responsible for perceiving fine visual detail. Light sensing cells in the macula, known as photoreceptors, convert light into electrical impulses and then transfer these impulses to the brain via the optic nerve. Central vision loss from Macular degeneration occurs when photoreceptor cells in the macula degenerate.

The Xcell-Center Macular Degeneration treatment
The stem cells are first collected from a patient’s bone marrow, extracted from the hipbone (iliac crest) then implanted back into the body days later. Prior to re-implantation of the cells, the bone marrow is processed in one of our labs, where the quantity and quality of the stem cells is also checked.

These re-injected stem cells have the potential to transform into multiple types of cells and are capable of regenerating damaged tissue. Our innovative stem cell treatments use the self-healing potential of each patient’s own body to stimulate regeneration or repair.

We believe that the retro-bulbar injection of autologous stem cells might first prevent the progression of dry and wet macular degeneration by reducing the Drusen deposits in the retinal pigment epithelium beneath the macula. It might also prevent the destruction of the photoreceptors in both the dry and wet type, by reactivating proper micro-vessel activity and reducing the abnormal blood vessel growth beneath.

Results
The following results are for one female patient, 45 years of age.

In the past, she had undergone several photodynamic laser macula treatments and two "lucentis" intra vitreo injections with a disastrous clinical result. Her clinical condition continued to worsen.

When she arrived at the Xcell-center for the first time, she had a central scotoma on the left eye and she was not able to count her fingers. In the right eye we observed the onset of macula degeneration with macula epiteliopathy and 9/10 corrected visual acuity that we have been able to preserve until the present.

After some detoxification treatments the patient was sent to the XCell-center on April 25, 2008 for a bilateral autologous stem cell retro-bulbar implantation.

Just two weeks after the treatment, during an objective, standardized examination, this patient showed significant improvement.

The next picture shows the Threshold Fovea Map. Clearly visible is the improvement in retinal sensitivity.


The following picture shows the Visual Fields. Here, too, one can see an improved retinal sensitivity.


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Another victim to POHS

My name is Rebecca. I was officially diagnosed with Ocular Histoplasmosis Syndrome in January of 2008. I grew up in Nashville, Tennessee and had never heard of the fungus Histoplasma Capsulatum until after moving to Grand Rapids, Michigan in August of 2007.

It is my hope from this blog that I can provide information to others about this terrible disease and urge people within the "Histo Belt" to check their sight on a regular basis.

INTERESTING VIDEOS

I've added some interesting videos of different retinal surgeries. I will warn you that these can be graphic, but if you're interested in knowing what surgeries have been done and how they work, take a peek!

Vitrectomy for Vitreous Opacities (Floaters)

Floaters - What are they? How do they happen?

Removal of Subretinal Neovascular Membrane due to OHS

Vitrectomy Surgery

Vitrectomy Surgery allows the Retina Surgeon to work inside of the eye and repair damage caused by a variety of diseases. The vitreous is the jelly inside the eye and is removed during the vitrectomy. YOU DO NOT NEED YOUR VITREOUS. The vitreous is important when the eye forms as a fetus grows into a baby, but it does nothing good for you after that. The vitreous is replaced with a salt solution or gas or oil and your body replaces the salt solution or gas in the vitreous cavity over a week or two.

Some vitrectomies can be performed using very small 25 gauge instruments. Most are done with 20 gauge instrument. Once the vitreous is removed, instruments like picks, forceps, lasers, and cautery can be used inside the eye to help fix problems like macular pucker, macular hole, retinal detachment, vitreous hemorrhage, diabetic retinal disease, infection, retained lens fragments and so on.

Vitrectomy surgery in our practice is usually done with local anesthesia and sedation. Since you will be sedated, YOU CANNOT EAT the morning of surgery. You will be sedated and your eye will be anesthetized. You will be monitored by an anesthesiologist or nurse anesthetist. After surgery you will have to wear a patch and shield over the eye until your appointment the following day.

If you have a retinal detachment and your doctor puts a gas or oil to hold your retina in place, you will have to hold your head in a certain position and also look in a certain position for the surgery to work. This is also true of surgery for macular holes which requires face down positioning.

After your patch is removed during your post-operative visit, you will need to take eye drops. If during the week after surgery, your eye starts to hurt more or vision starts to decline, you should call our office since that can indicate a problem with infection or elevated intraocular pressure. If you see a new shadow after surgery you need to call so we can check to make sure you do not have a retinal detachment.

Using modern microsurgical techniques, your retinal surgeon is able to repair many macular and retinal problems that were once thought unfixable. Your physician can tell you what the success rates are for your surgery including the possibility of some vision improvement and the possibility of a lot of vision improvement.

After any eye surgery there is a risk of infection, bleeding, and retinal detachment. Also, the intraocular pressure in the eye can sometimes rise necessitating extra post-operative eye drops. Make sure to call our office if you are having any problems.

What is Histoplasmosis?

Histoplasmosis is a disease caused when airborne spores of the fungus Histoplasma capsulatum are inhaled into the lungs, the primary infection site. This microscopic fungus, which is found throughout the world in river valleys and soil where bird or bat droppings accumulate, is released into the air when soil is disturbed by plowing fields, sweeping chicken coops, or digging holes.

Histoplasmosis is often so mild that it produces no apparent symptoms. Any symptoms that might occur are often similar to those from a common cold. In fact, if you had histoplasmosis symptoms, you might dismiss them as those from a cold or flu, since the body's immune system normally overcomes the infection in a few days without treatment.

However, histoplasmosis, even mild cases, can later cause a serious eye disease called ocular histoplasmosis syndrome (OHS), a leading cause of vision loss in Americans ages 20 to 40.

Where does Ocular Histoplasmosis Syndrome come from?

Scientists believe that Histoplasma capsulatum (histo) spores spread from the lungs to the eye, lodging in the choroid, a layer of blood vessels that provides blood and nutrients to the retina. The retina is the light-sensitive layer of tissue that lines the back of the eye. Scientists have not yet been able to detect any trace of the histo fungus in the eyes of patients with ocular histoplasmosis syndrome. Nevertheless, there is good reason to suspect the histo organism as the cause of OHS.

What are the symptoms of OHS?

OHS usually has no symptoms in its early stages; the initial OHS infection usually subsides without the need for treatment. This is true for other histo infections; in fact, often the only evidence that the inflammation ever occurred are tiny scars called "histo spots," which remain at the infection sites. Histo spots do not generally affect vision, but for reasons that are still not well understood, they can result in complications years--sometimes even decades--after the original eye infection. Histo spots have been associated with the growth of the abnormal blood vessels underneath the retina.

In later stages, OHS symptoms may appear if the abnormal blood vessels cause changes in vision. For example, straight lines may appear crooked or wavy, or a blind spot may appear in the field of vision. Because these symptoms indicate that OHS has already progressed enough to affect vision, anyone who has been exposed to histoplasmosis and perceives even slight changes in vision should consult an eye care professional.

How is OHS Diagnosed?

An eye care professional will usually diagnose OHS if a careful eye examination reveals two conditions: (1) The presence of histo spots, which indicate previous exposure to the histo fungus spores; and (2) Swelling of the retina, which signals the growth of new, abnormal blood vessels. To confirm the diagnosis, a dilated eye examination must be performed. This means that the pupils are enlarged temporarily with special drops, allowing the eye care professional to better examine the retina.

If fluid, blood, or abnormal blood vessels are present, an eye care professional may want to perform a diagnostic procedure called fluorescein angiography. In this procedure, a dye, injected into the patient's arm, travels to the blood vessels of the retina. The dye allows a better view of the CNV lesion, and photographs can document the location and extent to which it has spread. Particular attention is paid to how close the abnormal blood vessels are to the fovea.

Information on systemic histoplasmosis can be obtained from:

The National Institute of Allergy and Infectious Diseases (NIAID)The National Institutes of Health
Building 31, Room 7A50
31 Center Drive, MSC 2520
Bethesda, MD, 20892-2520
Telephone: 301-496-5717
Website: http://www.niaid.nih.gov