Clinical Efficacy of Platelet-Rich Plasma in the Treatment of Neurotrophic Corneal Ulcer

Abstract

Purpose Platelet-rich plasma (PRP) is an autologous blood product without preservatives and rich in proteins and growth factors which make it possible for cells to differentiate, proliferate, and migrate, thus stimulating healing and regeneration of tissues. The aim of this study was to evaluate the efficiency of autologous platelet-rich plasma in the treatment of neurotrophic keratopathy. Methods The study group consists of 25 patients with nonhealing corneal ulcers due to herpes simplex or herpes zoster infection and facial nerve or trigeminal nerve paralysis as a result of a neurosurgical operation caused by a tumour or stroke. The patients were given autologous platelet-rich plasma drops five times a day and additionally preservative-free artificial tears and a vitamin A ointment at night for maximum 3 months. The following were evaluated: best corrected visual acuity (BCVA), healing of corneal surface, subjective symptoms, and changes in corneal thickness with the use of anterior segment optical coherent tomography (AS-OCT). Results BCVA before the treatment was 0.10 ± 0.14, and after the treatment it was –0.3 ± 0.27 (p=0.001). Improved visual acuity and less subjective symptoms were observed in all patients. Complete healing of the ulceration was observed in 20 patients (80%). Four patients (16%) experienced considerable improvement of their clinical condition (reduced size and depth of the ulceration and inflammatory state: smaller conjunctival injection and swelling, improved visual acuity, and less subjective symptoms). In one of the patients, an amniotic membrane was transplanted due to the lack of improvement of his local condition. In all patients, the progression of corneal thinning was stopped. An average corneal thickness in its thinnest point was 322.3 ± 125.8 µm before the treatment, and 404.5 ± 118.7 µm (p < 0.05) after the treatment. None of the patients reported general or local side effects of the treatment. Conclusions Autologous platelet-rich plasma is a blood-based product which seems efficient in the treatment of neurotrophic keratopathy.

Blood-Based Treatments for Severe Dry Eye Disease: The Need of a Consensus

“…A complete resolution of corneal ulcer was reported in 97.4% of patients with NK after a mean time of 11.4 weeks [115]. Similar results were obtained in 25 NK patients treated by Wróbel-Dudzinska et al with PRP eye drops, with complete healing of the corneal ulcer observed in 80% of patients, while improved symptoms and visual acuity observed in all of them [118]. In a randomized clinical trial, Garcia-Conca et al compared PRP eye drops with tear substitutes in patients with hyposecretory DED [119].…”

Efficacy of a Semi Automated Commercial Closed System for Autologous Leukocyte- and Platelet-Rich Plasma (l-prp) Production in Dogs: A Preliminary Study

“…Interestingly, it is also possible to withdraw an aliquot of the L-PRP obtained from the collection bag in a sterile manner, so as to be able to keep the remainder for dermatological or oculistic periodic therapeutic treatments in the same subject. Shelf life of the remaining product may be prolonged by freezing, as carried is out in human medicine [ 75 , 76 ], though studies demonstrate that freezing is detrimental to platelet morphology and function and continuous synthesis of growth factors [ 36 ]. In veterinary medicine, there are few studies considering extension of the shelf life by freezing of platelet concentrates [ 54 , 77 , 78 , 79 , 80 ] and in the dog there are no literature reports that confirm the best preservation method.…”

Effects of autologous platelet-rich plasma coated sutures on intestinal anastomotic healing in rabbits

“…It is believed that PRP influences wound healing by stimulating tissue repair mechanisms, enhancing tissue healing and regeneration including bone, cartilage, tendon and muscle at various levels with minimal adverse effects (Albanese et al., 2013; Alsousou et al., 2013; Rah et al., 2017; Lang et al., 2018; Tambella et al., 2018a,b). Indeed, PRP has been used to enhance the healing process of various types of wounds (Kim et al., 2009; Alsousou et al., 2013; Picard et al., 2015; Alishahi et al., 2014; Tambella et al., 2014; Martinez-Zapata et al., 2016; Burgos-Alonso et al., 2018; Tambella et al., 2018a,b; Moneib et al., 2018), orthopaedics (Alsousou et al., 2013; Samy, 2016; Faillace et al., 2017; Marcazzan et al., 2018; Huang et al., 2019), ophthalmology (Ronci et al., 2015; Wróbel-Dudzińska et al., 2018; Alio et al., 2018), and dentistry (Del Fabbro et al., 2017; Tabrizi et al., 2018; Bhujbal et al., 2018; Saleem et al., 2018).…”