Autologous Serum and Platelet-Rich Plasma for Corneal Ulcers, Recurrent Erosions, and Dry Eyes

We are beginning to offer Platelet-Rich Plasma for our patients with Corneal Ulcers and dry eyes. 

Platelet-Rich Plasma (PRP) has been used for years in many different specialties. PRP is now being used to help heal patients with Corneal Ulcers, Recurrent Erosions, and Dry Eye as a way to stop the process of scar tissue formation and improve wound healing of damaged cells.  Though PRP has not been shown to restore meibomian glands yet, it has not been studied. I wonder if injecting PRP into the meibomian glands may help restore the glands. It may. Stem Cells though is likely better for injection into the Meibomian Glands. 

Platelet-Rich Plasma (PRP) is full of platelets which are good reservoirs of growth factors that improve wound healing and restore damaged ocular surfaces. 

We create PRP in a similar way we create autologous serum for a patient's own blood. We have been using Autologous Serum in hundreds of adults and children at Visionary Ophthalmology for about 25 years with very good results. I used Autologous Serum for adults at Harvard Medical School's Massachusetts Eye and Ear Infirmary rarely for many years when I was there on staff. 

For PRP, the blood is spun in a centrifuged to remove white and red blood cells to leave the platelets and growth factors. The plasma is placed into sterile eye droppers for topical administration. It is kept in the freezer until one plans to use it and then put in the refrigerator. They can be used for 1 week after defrosted. 

The biggest risk of using a blood product on a patient is a corneal infection. This is very rare but has been reported in patients who failed to keep the drops frozen or cold. I have not seen one yet from AS or PRP made in our office (nor at Harvard). Still any type of worsening while someone is using AS or PRP requires immediate attention and evaluation by an EyeMD. 

In future studies, a group of patients would have injection of Stem Cells in one eyelid and the other eyelid would be used as a control. Another set of patients would have PRP injected into the lower eyelid and the their other non-treated eye would serve as a control. 

Studies have shown Platelet rich plasma improved light sensitivity/photophobia, pain and inflammation. It helped reepithelialization of corneal epithelium, promoted corneal wound healing. It improved clinical conditions and resulted in improved vision in the majority of the patients

Sandra Lora Cremers, MD, FACS

Ophthalmology. 2007 Jul;114(7):1286-1293.e1. Epub 2007 Feb 26.

Use of autologous platelet-rich plasma in the treatment of dormant corneal ulcers.

Alio JL1, Abad M, Artola A, Rodriguez-Prats JL, Pastor S, Ruiz-Colecha J.

Author information

Abstract

PURPOSE:

To investigate the potential role of autologous platelet-rich plasma in promoting healing in dormant corneal ulcers.

DESIGN:

Prospective, consecutive, interventional, noncomparative, nonrandomized, observational study.

PARTICIPANTS:

Forty eyes of 38 patients with dormant corneal ulcers.

METHODS:

Autologous platelet-rich plasma was used in a total of 40 eyes with dormant corneal ulcers divided into 2 groups: group I, 26 eyes treated with topical eyedrops of autologous platelet-rich plasma (12 neurotrophic, 9 herpetic, and 5 immunological ulcers), and group II, 14 eyes treated surgically with a solid clot of autologous platelet-rich plasma combined with amniotic membrane transplantation in perforated corneas or with impending perforation. The treatment was used in patients with chronic nonhealing ulcers (mean, 2 years of evolution) that had been unresponsive to conventional topical therapy. Autologous blood from each patient was obtained by venipuncture, and platelet-rich plasma was prepared from each blood sample without additives.

MAIN OUTCOME MEASURES:

Ulcer size, inflammation, healing, visual acuity, and patient's subjective symptoms.

RESULTS:

Autologous platelet-rich plasma promoted healing of ulcers. In group I, 13 eyes healed, 11 eyes improved significantly, and 2 eyes showed no change. In group II, 10 eyes healed and 4 eyes improved significantly. Inflammation and subjective symptoms, particularly pain, improved in all patients. Vision remained stable or improved in all cases.

CONCLUSION:

Autologous platelet-rich plasma promoted healing of dormant corneal ulcers even in eyes threatened by corneal perforation and was accompanied by a reduction in pain and inflammation.

• Alio JL, Abad M, Artola A, et al. Use of autologous platelet-rich plasma in the treatment of dormant corneal ulcers. Ophthalmology. 2007.114:1286-1293.
• Kojima T, Ishida R, Dogru M, et al. The effect of autologous serum eye drops in the treatment of severe eye disease: a prospective randomized case-controlled study. Am J Ophthalmol. 2005;139:242-246.
• Tsifetaki N, Kitsos G, Paschides CA, et al. Oral pilocarpine for the treatment of ocular symptoms in patients with Sjögren’s syndrome: A randomised 12-week controlled study. Ann Rheum Dis. 2003;62:1204-1207.

Plast Reconstr Surg. 2012 Jan;129(1):46e-54e. doi: 10.1097/PRS.0b013e3182362010.

Nonactivated versus thrombin-activated platelets on wound healing and fibroblast-to-myofibroblast differentiation in vivo and in vitro.

Scherer SS1, Tobalem M, Vigato E, Heit Y, Modarressi A, Hinz B, Pittet B, Pietramaggiori G.

Author information

Abstract

BACKGROUND:

Platelet preparations for tissue healing are usually preactivated before application to deliver concentrated growth factors. In this study, the authors investigated the differences between nonactivated and thrombin-activated platelets in wound healing.

METHODS:

The healing effects (i.e., wound closure, myofibroblast formation, and angiogenesis) of nonactivated and thrombin-activated platelets were compared in experimental wounds in diabetic (db/db) animals. In vitro, fibroblast phenotype and function were tested in response to platelets and activated platelets. No treatment served as a negative control.

RESULTS:

Wounds treated with platelets reached 90 percent closure after 15 days, faster than activated platelets (26 days), and with higher levels of myofibroblasts and angiogenesis. In vitro, platelets enhanced cell migration and induced two-fold higher myofibroblast differentiation and contraction compared with activated platelets.

CONCLUSIONS:

Platelets stimulate wound healing more efficiently compared with activated platelets by enhancing fibroblast differentiation and contractile function. Similar levels of growth factors may induce different biological effects when delivered "on demand" rather than in an initial bolus.

PRP can be frozen but fresh is better.

BioMed Research International
Volume 2014 (2014), Article ID 692913, 10 pages
http://dx.doi.org/10.1155/2014/692913

Research Article

Does Platelet-Rich Plasma Freeze-Thawing Influence Growth Factor Release and Their Effects on Chondrocytes and Synoviocytes?

Alice Roffi,1 Giuseppe Filardo,2 Elisa Assirelli,3 Carola Cavallo,4 Annarita Cenacchi,5 Andrea Facchini,6,7 Brunella Grigolo,3 Elizaveta Kon,2 Erminia Mariani,6,7 Loredana Pratelli,8 Lia Pulsatelli,3 and Maurilio Marcacci2

1Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Via di Barbiano 1, 40136 Bologna, Italy
2II Clinic-Biomechanics Laboratory and Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy
3Laboratory of Immunorheumatology and Tissue Regeneration/RAMSES, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy
4Laboratory RAMSES, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy
5Immunohematology and Transfusion Medicine and Cell and Musculoskeletal Tissue Bank, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy
6Laboratory of Immunorheumatology and Tissue Regeneration Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy
7Department of Medical and Surgical Science, University of Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, Italy
8Clinical Pathology Unit, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy

Received 27 February 2014; Accepted 23 June 2014; Published 17 July 2014

Current research aims to optimize PRP production and administration protocols. This study underlines two interesting aspects. The first one is that freeze/thawing affects PRP cell composition and its release of bioactive molecules. The second is that this different release kinetics does not significantly influence the effects on cell cultures. It is important to recognize that biological studies give important indications for the development of treatments, but their results do not always directly translate into clinical findings, as previously shown by the same clinical outcome reported using two biologically completely different procedures [35]. However, until clinical studies explore and clarify the effects of PRP storage on patient symptoms and functional improvement, this study suggests that freeze/thawing does not significantly affect PRP and can be considered as a storage option and thus simplify the management of patients undergoing multiple injection cycles of PRP.