Retinal Prosthesis posts encouraging results in clinical trial


Retinal Prosthesis posts encouraging results in clinical trial.

A clinical trial of the Argus II Retinal Prosthesis involving 30 patients has produced enc...

A clinical trial of the Argus II Retinal Prosthesis involving 30 patients has produced encouraging results

After receiving European market approval for its Argus II Retinal Prosthesis in 2011, Second Sight has published interim results of an international clinical trial showing encouraging results in blind patients suffering severe retinitis pigmentosa (RP) – a group of genetic degenerative eye conditions that leads to incurable blindness.

The Argus II captures video images using a miniature camera housed in the patient’s glasses and converts them into a series of small electrical pulses that are wirelessly transmitted to an array of electrodes on the surface of the retina. These pulses are designed to stimulate the retina’s remaining cells which send messages along the optic nerve to the brain. The brain is then able to perceive patterns of light and dark spots corresponding to which electrodes have been stimulated.

The multicentered, long-term, controlled clinical trial involved 30 patients who were implanted with the Argus II Retinal Prosthesis, which is the only retinal prosthesis in the world so far approved for sale in Europe. The patients’ progress was followed for periods of between six months and 2.7 years and they underwent a series of visual acuity tests performed using computer monitors – square localization, direction of motion and grating visual acuity. The patients were also given two types of real-world orientation and mobility (O&M) tests. These involved finding a door across a room and following a white line on the floor.

Results published in the journal Ophthalmology indicate significant improvements in the O&M tasks, as well as improvements of 96 percent in object localization, 57 percent in motion discrimination, and 23 percent in the discrimination of oriented gratings.

Second Sight says the results demonstrate the reliability and efficacy of the Argus II and that the safety profile of the prosthesis is comparable to other ophthalmic devices and procedures.

“The Argus II can, quite simply, help the blind see,” said Dr. Stanislao Rizzo, Director of the U.O. Chirurgia Oftalmica, Azienda Ospedaliero Universitaria Pisana of Pisa, who on October 29, 2011, became the first surgeon to implant Argus II following European market approval. “Having an approved device backed by significant clinical data is cause for great hope among those patients suffering from RP. There is finally a real solution that means that their vision can be partially restored, safely.”

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UK trials for new blood transfusion protocols


BBC News – UK trials for new blood transfusion protocols.

BBC News - UK trials for new blood transfusion protocols

Clinical trials are under way in the UK of new blood transfusion procedures for patients with traumatic injuries.

A study involving 22 centres in England and Wales is assessing how changing the mix of blood components given can affect outcomes.

The new trials aim to determine what is the optimal mix of red blood cells and plasma given to trauma patients.

New blood protocols have been used by US and British forces in Iraq and are credited for improved survival rates.

Catastrophic haemorrhage

Modern blood transfusions involve the intravenous injection of blood components such as red blood cells, platelets and plasma, a straw-coloured blood component which acts as a clotting agent.

Until recently, plasma was given in the UK only once a blood test deemed it necessary, but this could mean valuable time was lost in stopping a patient from bleeding to death. The plasma also has to be thawed.

In recent years, military and civilian centres worldwide have been looking to use plasma early and in higher volumes with traumatic injuries. Less use of saline fluids has also been made in the immediate aftermath of an injury, for fear it will reduce clotting.

A retrospective study published in 2007 of 246 patients treated at a US combat support hospital in Iraq found a direct association between the amount of plasma given and survival rates.

The study, which involved only patients with severe injuries and massive blood loss, suggested the mortality rate fell from 65% to 19% when the ratio of plasma to red blood cells administered was cut from 1:8 to approximately 1:1.

Plasma is also being used early and aggressively in Afghanistan, as seen by BBC documentary maker Michael Mosley in his forthcoming BBC2 programme Frontline Medicine, and NHS trauma centres and trusts have adopted similar procedures.

Other clotting factors and a drug called tranexamic acid that reduces the break-up of clotting, are also being used.

BBC News - UK trials for new blood transfusion protocols

But what exactly is the right mix of components for trauma patients is still to be agreed. Other studies have showed no benefits of the 1:1 ratio favoured by the military.

Prof Karim Brohi, of the Barts and The London Trauma Centre, is leading two clinical trials to investigate which blood products work best, in what ratio, and which other devices or procedures could be used to save lives.

One trial involves more than 1,000 patients from centres in London, Oxford, Copenhagen and Oslo. The second involves 600 patients at 22 medical centres in England and Wales, and will follow surviving patients for a year after injury.

Preliminary data suggests that a 1:2 ratio of plasma to red blood cells may be “as good as if not better” than the 1:1 ratio, said Professor Brohi.

“Around the world, 2.5 million people bleed to death each year,” he told the BBC. “That’s more than die from HIV and Malaria and a lot of those deaths are preventable.

“We’re trying to work out what are the underlying problems that go along with that, so that we can treat patients better so they survive and return to full health.”

Making a difference

The new transfusion procedures are also impacting upon the work of London’s Air Ambulance, which is based during the day at the Royal London Hospital.

While they cannot yet carry blood on board, they are using a new code to instruct teams at the Royal London to ready all the products needed, including plasma. Blood units can even be brought up to the helipad.

Code Red is a protocol we use to pre-alert the hospital to make sure that patients we pick up from the roadside who are bleeding get the blood products that they require as soon as they arrive at hospital,” explains Dr Anne Weaver, lead clinician with London’s Air Ambulance.

She says the new code appears to be making a difference.

“At the Royal London we’ve seen an improvement in the survival rates of patients with severe pelvic trauma. That’s partly to do with the Code Red protocol, and partly to do with interventional radiology and packing of the pelvis.”