Cuban Treatment for Retinitis Pigmentosa

Cuban therapy for the treatment of Retinitis Pigmentosa consists of the combination of the following procedures

Content of this page

  1. Cuban therapy for retinitis pigmentosa
  2. Surgical treatment
  3. Pre-assessment considerations
  4. Description of the surgical technique
  5. Contraindications of surgery
  6. Medicines

Given the severe limitations that Retinitis Pigmentosa represents for those who suffer from it, mostly young people, a team of Cuban scientists, led by Prof. Dr. Orfilio Pelá ;ez Molina, dedicated himself to For more than forty years I have been studying the therapeutic possibilities to stop the progression of this disease.

The treatment for Retinitis Pigmentosa in Cuba consists of performing a surgical technique that is combined with other therapies in addition to surgery.

The leading clinic for this treatment against Retinitis Pigmentosa in Cuba is the Camilo Cienfurgos International Center for Retinitis Pigmentosa.

This is a "revitalizing" surgery of the eye consisting of a transplant of orbital vascular adipose tissue, in a pedunculated form, which is located in the suprachoroidal space and which, through an angiogenesis mechanism, contributes to improving the function of still active photoreceptors.



The surgical procedure for the treatment of Retinitis Pigmentosa is essential because it has a more effective action on the stabilization of the disease.

The surgical technique for the treatment of Retinitis Pigmentosa is indicated when there is a significant loss of the visual field in patients with a diagnosis of Retinitis Pigmentosa, above what is expected annually, that is, approximately 4%; when there are visual field restrictions greater than 20%. Also in cases in which there is already central involvement associated with peripheral losses, determined by loss of visual acuity in 4 lines of the Snellen chart.


Pre-surgery evaluation considerations

  1. Confirmatory diagnosis of Retinitis Pigmentosa.
  2. Assessment of the clinical stage, a very important aspect to perform the surgical technique according to possible modifications.
  3. Assess the hemodynamic status of the patient.
  4. Analyze the state of vision and visual field.
  5. Know the history of other ocular and systemic diseases.
  6. Assessment by the Internist, the Pediatrician, if children are involved, and by the team of anesthesiologists.

Taking into account the result of the different assessments already mentioned, we are in a position to carry out the surgical treatment strategy for  Retinitis Pigmentosa. Treatment is specific for each person.


Description of the surgical technique.

After the asepsis, antisepsis and preparation of the operating field measures, the procedure will be performed. according to the following steps

  1. Incision of the conjunctiva: will cover approximately 60°, in the temporal quadrant that has been selected. In some patients, due to difficulties in obtaining a good surgical field, larger incisions will be made.;s extensive. It is important to make an incision of the conjunctiva that allows the identification and opening of the Tenon capsule. It must be carried out meticulously to avoid difficulties in subsequent procedures, using curved Kelly forceps to separate the visceral leaf of the Tenon capsule from the bulb of the eye, making the virtual suprasclerotical space of Tenon real.

  2. Identification and fixation of the muscles: the rectus muscles corresponding to the surgical area are identified, which will be fixed with 3-0 silk, which will pass through the surgical area. below these. Any fins that remain tense will be released using a moistened applicator, to avoid muscle trauma.

  3. Surgical position of the eye and identification of anatomical references: the ends of the silk threads that fix the muscles are moved, so that movement occurs around the center of rotation of the eye, with which the posterior segment moves obliquely, visualizing itself; and the previous segment is hidden. This is achieved by placing the threads crosswise, at an approximate angle of 60 °. We use a separator or recliner designed by Professor Peláez or also using a Desmarres separator and strabismus hooks to separate redundant conjunctiva and expose the surgical field adequately. The scleral insertion of the inferior oblique muscle, the emergence of the vasa vorticosa and the orbital vascular adipose tissue are located.

  4. Hemostasis: Possible remnants of suprasclerotical loose connective tissue are released using an applicator. Cauterization of the episcleral vessels is carried out in the area of the surgical area.

  5. Sclerotomy: A non-perforating sclerotomy is performed in a line parallel to the limbus, located between the rectus muscles of the chosen quadrant, 3 mm posterior to its scleral insertion and away from it. 2 mm of their travel. The incision will have an average extension of 10 mm, which varies depending on the size of the eye and the location of the muscle insertions. From now on, the incision is deepened using the scalpel. in an oblique position so that the dark coloration of the choroid is visualized through the deepest scleral fibers and the lamina fusca. In this way, we have the cleavage plane in which we will work.

    Lateral incisions are made, parallel to each other. and that they extend in an anteroposterior direction as the lamellar sclerotomy progresses, maintaining the desired epicoroidal plane. To advance, first the scalpel is used as an aid. and then Vannas scissors and scarifier.

    The incision close to the inferior oblique muscle passes about 2 mm from it and ends 2-4 mm from its posterior end. The lateral incision that enters in relation to the vasa vorticosa changes its direction and approaches the center of the scleral flap to avoid injury to the vessel and extends towards the posterior pole until reaching a position of approximately 6 mm. of the posterior end of the insertion of the inferior oblique muscle and the vasa vorticosa.

    The lamellar sclerotomy is completed in the direction of the vicinity of the insertion of the oblique (inferior) muscle where extreme care must be taken due to its relationship with the macular area.

  6. Microincisions: with the scalpel In a vertical position, microincisions are made in the epicoroidal bed, which must be parallel to each other. and intersect obliquely to create a trellis.

  7. Identification of the orbital adipose tissue, dissection and selection of the fragment to be grafted: in direct relation to the bulb of the eye and in the directionPosteriorly, the orbital adipose tissue remains covered by the capsule. This makes a certain protrusion between the oblique muscle that goes towards its orbital insertion and the end of the scleral flap that is most posterior and closest to the vorticose. This tissue is clamped and separated from the surrounding tissue by blunt dissection using an applicator and Kelly clamp. When pulling it, care is taken not to disturb the area close to the vasa vorticosa or the muscle, so as not to injure them. Incisions are made in the portion of its fibrous capsule that is located towards the bulb of the eye, in the fibrous tracts that go towards the interior of the adipose tissue and simultaneously, 2 parallel, separate lateral incisions are made. about 6-9 mm, which allows the tissue to move from its posterior position towards the line of the initial sclerotomy. In this way it is joined by a pedicle made up of its capsule and posterior extensions, in which tissue and vascular continuity is maintained.

  8. Fixation of the orbital vascular adipose graft to the sclerochoroidal bed using sutures: the vascular fat pedicle is fixed using 7.0 or 8.0 virgin silk stitches, to the most posterior edge of the lip anterior of the initial sclerotomy; It is fixed to the angles that form the initial incision and the incisions in an anteroposterior direction. Of these two ends, it is preferred to start at the end that is furthest from the place of origin of the pedicle, to This ensures its appropriate extension on the epicoroidal bed and at the same time checks that its length is appropriate to remain free of tension. It will be sutured then towards the most posterior edge of the sclerotomy that borders the oblique muscle at its most posterior end. With this, the tissue is spread over the epicoroidal bed and it is easily observed that the vascular adipose tissue consists of the following parts: neck, body, head.

  9. Repositioning and fixation of the scleral fragment: the scleral flap is extended, covering the graft. The sclerotomy is closed with single sutures or continuous sutures. It is preferred to start at the ends and then suture the edge in relation to the inferior oblique muscle, so that scleral tensions are more adequate. Care must be taken that the vascular adipose tissue is completely covered by the sclera to prevent possible post-operative fibrosis, for which it must be invaginated into the flap of the adipose graft, when necessary.

  10. Closing of the conjunctiva: the conjunctiva is closed using surget.

  11. Use of local or subconjunctival antibiotics and cycloplegic mydriatic eye drops, if there is no contraindication.

  12. Occlusion of both eyes for a period of approximately 24-72 hours.


Indications for surgery

The technique is indicated when there is a loss of visual field or visual acuity in patients diagnosed with Retinitis Pigmentosa with visual field restrictions greater than 20°. and central involvement that reduces visual acuity to 0.6 together with peripheral losses of the visual field.

This surgery may be useful in the treatment of other retinal dystrophies and conditions caused by retinal ischemia.


Contraindications of surgery

  1. Retinal detachment surgery, which hinders the performance of the surgery.
  2. Untreated retinal detachment.
  3. Staphyloma, which due to its extension or the degree of thinning of the sclera may present a risk of perforation.
  4. Active inflammatory processes of the eye.
  5. Vitreoretinal hemorrhages.
  6. Infectious processes of the eye
  7. People with systemic diseasesimportant symptoms that compromise the life of the patient or the result of eye surgery.
  8. In children under 8 years of age, assess the anteroposterior diameter of the eye.



Its application may vary according to the age of the patient, systemic and ocular alterations associated with Retinitis Pigmentosa, and the indication, concentration and sessions are not constant.

The administration route in the patient with Retinitis Pigmentosa can be: rectal and intravenous (autohemotherapy), administering it daily for 15 days; the dosage is regulated by the weight and age of the patient.


Electrostimulation is performed using equipment that emits low-intensity sinuosity electrical energy.

The electrodes are applied to symmetrical points on the body; The most selected in Retinitis Pigmentosa are those of the parietal and temporal, periorbital and cervical regions. They can also be applied to the plantar region of the lower limbs and the palms of the hands.

The action of this therapy is to produce a micromassage at the level of the blood capillaries and lymphatic circulation. Through this, the electroion balance of the person under study can be assessed. If the answer is not similar in symmetrical points, then it is a mistake. in the presence of a person with an electroion imbalance and their prognosis is more reserved, as long as this imbalance is maintained for a longer time.

The number of applications is variable, its average ranges between 10 and 15 sessions, with a duration of 5 minutes for each selected region.


Contraindications for the application of electrostimulation

In patients who have had metal prostheses implanted in the knees, skull and other organs; example, pacemaker.



Depending on the characteristics of each patient, it is considered to complement the treatment for Retinitis Pigmentosa with other medications.

When marked retinal and choroidal vascular damage is observed, medications with hemorrheological action are used. Cellular antichemic agents are used when there is great compromise in visual acuity, choroidal damage, and macular damage. Oxide reducers are indicated to protect against oxidative damage to the ocular structures, caused by free radicals. We recommend the ingestion of Lutein to protect against macular damage, which is very common in these patients.

In all cases in which some type of drug therapy is indicated, the patient's health status, possible allergy to the drug, its toxic action, contraindications and possible side effects must be previously assessed.



  1. Protection of the eyes from ultraviolet radiation with glasses.
  2. Do not smoke, due to the harmful effects of smoking.
  3. Do not take retinotoxic medications, as they accelerate the damage of the photoreceptors.
  4. Perform systematic exercises.
  5. Diet rich in fruits, vegetables, legumes and low fat.


Cuban Treatment for Retinitis Pigmentosa
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