Non-arteritic anterior ischemic optic neuropathy (NAION) is a leading cause of optic nerverelated permanent visual impairment among individuals of over 50 years of age after glaucoma. Due to perplexing disorder regarding its pathogenesis, there is still no widely accepted and established treatment plan. Mesenchymal stem cells (MSCs) are one of the rare stem cell types that therapeutic agents for immunomodulation and ischemic tissue repair in clinical practice. However, there are certain disadvantages in using MSCs, such as potential tumorigenicity, need for autologous collection, and short survival time. Previous evidence suggested that MSC-exosome significantly attenuated post-ischemic neuronal damage and induced long-term neuroprotection associated with enhanced angiogenesis in MSCs.

Therefore, we hypothesized that the intravitreal administration of MSC-exosome could be a potentially effective therapeutic approach for NAION by using a similar mechanism via promoting angiogenesis, neuro-regeneration, and neurological recovery, suppressing oxidative stress and reducing apoptosis, and suppressing inflammation and immunity based on its biological structure and function in NAION. Questions that need to be answered before testing clinically include dose regimen, injection frequency, the optimal duration of treatment, and duration of medication.

非动脉炎性前部缺血性视神经病变 (NAION) 是青光眼后 50 岁以上个体视神经相关永久性视力障碍的主要原因。由于其发病机制复杂，至今尚无被广泛接受和确立的治疗方案。间充质干细胞 (MSCs) 是临床实践中用于免疫调节和缺血组织修复的治疗剂的罕见干细胞类型之一。然而，使用 MSCs 存在某些缺点，例如潜在的致瘤性、需要自体采集以及存活时间短。先前的证据表明，MSC-外泌体显着减轻了缺血后神经元损伤，并诱导了与增强的 MSC 血管生成相关的长期神经保护作用。

因此，我们假设玻璃体内注射 MSC-外泌体可能是一种潜在有效的 NAION 治疗方法，通过促进血管生成、神经再生和神经恢复、抑制氧化应激和减少细胞凋亡、抑制炎症和免疫等类似机制。基于其在 NAION 中的生物学结构和功能。临床试验前需要回答的问题包括给药方案、注射频率、最佳治疗持续时间和用药持续时间。