Данный обзор посвящен современным методам терапии персистирующих эпителиальных дефектов роговицы. Рассмотрены основные факторы, влияющие на развитие этой патологии, обсуждается влияние лимбальной недостаточности как одного из наиболее вероятных факторов развития. Описаны наиболее перспективные методы лечения, а именно применение различных дериватов крови и клеточной терапии. Ключевые слова: персистирующий эпителиальный дефект роговицы, лимбальная недостаточность, аутологичная сыворотка, богатая тромбоцитами плазма, клеточная терапия.
The problem of the restoration of the epithelial layer after various modifications of keratoplasty is of great fundamental interest. In this regard, new methods of induction of regeneration are being developed; one of the promising approaches in this area is the use of autologous blood derivatives with a high regenerative potential. Objective: to compare the effect of 3 blood derivatives serum, platelet-rich plasma and plasma rich growth factors on the culture of corneal epithelial cells. The study was carried out on cells of the epithelium of the human cornea of passage 3. To confirm corneal affiliation, cells were typed for characteristic cytokeratins. The dynamics of migration was assessed in the test for wound healing of the monolayer. Proliferation was assessed by the results of the formazan test. Plasma rich growth factors had the greatest stimulating effect on cell proliferation. There were no significant differences between groups in the rate of wound healing of the monolayer. It was found that, in comparison with the control, all stimulants shift the morphological phenotype of cells to a more mature side. As a result of the study, it was shown that all 3 types of tested blood derivatives are promoters of corneal re-epithelialization. The use of drugs obtained from blood can positively influence the processes of epithelialization in persistent epithelial corneal defects, which requires further study.
AIM:to evaluate the effectiveness of the platelet-rich plasma lysate (PRP lysate) use in the treatment of persistent epithelial defects (PED) after keratoplasty.
MATERIALS AND METHODS:In the study, 60 patients with PED after keratoplasty were included. The 1st group (24 cases)included patients after keratoplasty with low risk of rejection, and the 2nd group 36 cases after keratoplasty with highrisk of rejection. Each group was divided into two subgroupscontrol subgroups 1a (cases 10) and 2a (cases 16), where patients received only standard postoperative therapy, and the main subgroups 1b (cases 14) and 2b (cases 20), in which PRP lysate was prescribed against the background of standard therapy, starting from the Day 15 post-op. As the criterion for effective treatment, complete persistent epithelialization after keratoplasty was considered.
RESULTS:The effectiveness of the use of PRP lysate in the subgroup 1b was 85.7%, while complete epithelialization in the control subgroup 1a was recorded in 70%; in the subgroup 2b, complete epithelialization was observed in 55%, in the control subgroup 2ain 43.75%.
CONCLUSION:The use of PRP lysate in the treatment of PED after corneal transplantation as an adjuvant therapy is effective and safe in both high and low risk keratoplasty. In the examined category of patients, treatment with blood derivatives increases the frequency and rate of complete epithelialization.
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