Management of Retinitis Pigmentosa Via Electromagnetic Stimulation and Platelet Rich Plasma
Condition: Retinitis Pigmentosa
MeSH terms: Retinitis; Retinitis Pigmentosa
Study type: Interventional

Summary: 
      The aim of this study is to investigate whether natural progression rate can be slowed down
      with subtenon PRP or PRP application combined with rEMS in retinitis pigmentosa cases.
    

Detailed description: 
      Retinitis pigmentosa (RP) is a progressive external retinal degeneration resulting from
      mutation in any of the 260 genes found in the retinal pigment epithelium (RPE). The
      progression rate and findings of the disease are heterogeneous according to genetic mutation
      and heredity type. The initial symptom of the disease is usually night blindness (nyctalopia)
      beginning in childhood or adolescent period. Narrowing in the visual field and legal
      blindness develops as the disease progresses. If low grade inflammation is added, the disease
      is complicated by cataracts, epiretinal membrane and macular edema. In the fundus
      examination, the appearance of midperiferal bone spicule pigmentation is usually sufficient
      to diagnosis. Developments in optical coherence tomography (OCT) technology enable detailed
      imaging of the sensorial retina and the ellipsoid zone. The ellipsoid zone (EZ) is an image
      of the inner and outer segments of photoreceptor cells. Loss of EZ is considered the gold
      standard in the diagnosis and follow-up of RP. Visual field monitoring and
      electroretinography (ERG) are indirect signs of EZ loss and correlated with EZ width.
      Mutations in RPE disrupt the synthesis of some vital peptide and growth factors for
      photoreceptors.

      Platelet-rich plasma (PRP) is a good source of growth factors. Platelets have more than 30
      growth factors and cytokines in α-granules such as neurotrophic growth factor (NGF), neural
      factor (NF), brain derived neurotrophic factor (BDNF), basic fibroblast growth factor (bFGF),
      insulin-like growth factor (IGF), transforming growth factor (TGF-β), vascular endothelial
      growth factor (VEGF), platelet derived growth factor (PDGF) etc. These peptides regulate the
      energy cycle at the cellular level, local capillary blood flow, neurogenesis and cellular
      metabolism. Anti-inflammatory effects of PRP are also associated with soluble cytokines.

      Repetitive electromagnetic stimulation (rEMS), increases binding affinity and the synthesis
      of growth factor receptors on neural tissues. It provides electromagnetic iontophoresis by
      changing the electrical charges of tyrosine kinase receptors (Trk). rEMS forms
      hyperpolarization-depolarization waves in neurons, thereby increasing neurotransmission and
      capillary blood flow. Trk receptors are commonly found around limbus, extraocular muscle
      insertions and the optic nerve. Molecules smaller than 75 kD can pass from the sclera
      passively to the suprachoroidal space. Electrical or electromagnetic iontophoresis is
      required for molecules larger than 75kD such as BDNF and IGF to pass through the sclera.

      The aim of this study is to investigate whether natural progression rate can be slowed down
      with subtenon PRP or PRP application combined with rEMS in retinitis pigmentosa cases.
    

Intervention name(s): PRP combined Magnovision; PRP
Intervention type(s): Combination Product; Biological
Intervention description(s): The rEMS helmet is used to stimulate the retina and visual pathways. (MagnovisionTM) combined with subtenon platelet rich plasma injection; Fresh autologous platelet rich plasma, injected subtenon space.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: Comparative, open label
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Retinitis pigmentosa; Electromagnetic stimulation; Platelet rich plasma; Magnovision; Ellipsoid zone