Vision Loss after Intravitreal Injection of Autologous "Stem Cells" for AMD

Abstract

Adipose tissue-derived "stem cells" have been increasingly used by "stem-cell clinics" in the United States and elsewhere to treat a variety of disorders. We evaluated three patients in whom severe bilateral visual loss developed after they received intravitreal injections of autologous adipose tissue-derived "stem cells" at one such clinic in the United States. In these three patients, the last documented visual acuity on the Snellen eye chart before the injection ranged from 20/30 to 20/200. The patients' severe visual loss after the injection was associated with ocular hypertension, hemorrhagic retinopathy, vitreous hemorrhage, combined traction and rhegmatogenous retinal detachment, or lens dislocation. After 1 year, the patients' visual acuity ranged from 20/200 to no light perception.

Figure 1. Findings on Ophthalmologic Examination in Patient 1

In Panel A, a high-resolution ultrasonographic image shows anterior subluxation of the lens of both eyes, more prominently in the left eye. In Panel B, a posterior segment ultrasonographic image shows moderately dense, mobile vitreous opacities with macular thickening in both eyes and possible retinal detachment and vitreoretinal adhesions in the left eye. In Panel C, fundus photographs of both eyes show diffuse intraretinal hemorrhage. The view is hazy in the left eye because of corneal edema. In Panel D, an optical coherence tomographic image of the right eye shows macular thickening without cystoid macular edema. The thickening is more prominent in the inner retina (arrow). In Panel E, a fluorescein angiogram of the right eye shows blockage from the hemorrhages (arrows), a window defect in the temporal macula, and an area of staining in the temporal periphery. No vasculitis was seen. Fluorescein angiography of the left eye could not be performed because of severe corneal edema.

Figure 2. Findings on Ophthalmologic Examination in Patients 2 and 3

In Panel A, fundus photographs of both eyes in Patient 2 show intraretinal hemorrhage and vitreous hemorrhages. In Panel B, an optical coherence tomographic (OCT) image shows macular thickening without cystoid macular edema and an epiretinal membrane in the right eye and retinal thickening without cystoid macular edema and geographic atrophy in the left eye in Patient 2. An old scar caused by laser retinopexy is visible in the superotemporal quadrant of the right eye (arrow). In Panel C, a fluorescein angiogram shows blockage from the hemorrhages, areas of staining temporally, and a window defect in the central macula in both eyes in Patient 2. No vasculitis was seen. In Panel D, montage fundus photographs of both eyes in Patient 2 show bilateral attached retinas with peripheral laser chorioretinal scars. In Panel E, fundus photographs of both eyes in Patient 3 show severe combined tractional and rhegmatogenous retinal detachment with proliferative vitreoretinopathy in the right eye and geographic atrophy in the left. An old scar caused by cryopexy is visible in the superotemporal quadrant of the left eye (arrow). In Panel F, an OCT image of the left eye in Patient 3 shows geographic atrophy.