導讀：NEW YORK (Reuters Health) - Structural and functional recovery is rapid after limited iatrogenic macular detachment for retinal gene therapy, according to Australian and UK investigators.

        NEW YORK (Reuters Health) - Structural and functional recovery is rapid after limited iatrogenic macular detachment for retinal gene therapy, according to Australian and UK investigators.

        As Dr. Matthew P. Simunovic explained in an email to Reuters Health, "Naturally occurring retinal detachments are recognized as sight-threatening and form the bulk of emergency procedures performed by retinal surgeons. Our article explores whether a surgically induced retinal detachment has a negative effect on the retina in patients undergoing gene therapy for an inherited retinal disease called choroideremia."

        In a February 2 online paper in JAMA Ophthalmology, Dr. Simunovic of the University of Sydney and colleagues report on five men ages 23 to 71.

        "In the process of gene therapy," Dr. Simunovic said, "we removed the vitreous - the gel that fills the inside of the eye - and then injected a small volume of fluid containing the gene therapy solution under the central retina. Our results suggest that the retina reattaches very quickly (within one week) after the procedure and that the structure of the central retina is not affected."

        In fact, at one month the mean increase in visual acuity was 5.4 letters in treated eyes and 0.8 letters in control eyes.

        Thus, said Dr. Simunovic, "the function of the central retina appears to recover by one month (though one patient had some persistent and subtle changes to his color vision)."

        He concluded, "The findings are important as they suggest that surgically induced retinal detachment has minimal effects on the central retina in our subjects: similar procedures may be used in the future to treat other inherited retinal diseases (which as a whole affect 1 in 3,000 to 4,000 individuals and which constitute the commonest cause of blindness registration in those of working age)."

        Commenting by email, Dr. Jacque L. Duncan, author of an accompanying editorial, told Reuters Health that "a number of new treatments (including gene and cell-based therapies) are being developed for patients who are affected by inherited retinal degenerations, and due to the nature of the diseases, the treatments are being designed to be delivered into the space beneath the retina."

        Dr. Duncan of the University of California, San Francisco, added, "The effect of creating a retinal detachment to deliver treatment to the subretinal space in patients with retinal degeneration hasn't been fully characterized; creating a retinal detachment may damage vision cells, which may reduce the effect of the therapy."

        "For this reason," he concluded, "research to understand the impact that retinal detachment has on photoreceptors, and research to develop other ways to deliver treatments for retinal degenerations are both critically needed to develop treatments for these vision-threatening diseases."

        SOURCE: http://bit.ly/2kTlSPI and http://bit.ly/2lr878z

        JAMA Ophthalmol 2017.