Plasma rich in growth factors membrane as coadjuvant treatment in the surgery of ocular surface disorders

Abstract

To evaluate the safety and efficacy of the surgical use of plasma rich in growth factors fibrin membrane (mPRGF) in different ocular surface pathologies.Fifteen patients with different corneal and conjunctival diseases were included in the study. Patients were grouped according to the use of mPRGF as graft (corneal and/or conjunctival) or dressing; they were also grouped according to the surgical subgroup of intervention (persistent corneal ulcer [PCU], keratoplasty, superficial keratectomy, corneal perforation, and pterygium). Best corrected visual acuity, intraocular pressure (IOP), inflammation control time (ICT), mPRGF AT (PRGF membrane absorption time), and the healing time of the epithelial defect (HTED) were evaluated throughout the clinical follow-up time. Safety assessment was also performed reporting all adverse events.mPRGF showed a total closure of the defect in 13 of 15 patients (86.7%) and a partial closure in 2 patients (13.3%). The mean follow-up time was 11.1 ± 4.2 (4.8-22.8) months, the mean ICT was 2.5 ± 1.1 (1.0-4.0) months, the mean mPRGF AT was 12.4 ± 2.0 (10.0-16.0) days, and for the global HTED the mean was 2.9 ± 1.2 (1-4.8) months. Results showed an improvement in BCVA in all patients, with an overall improvement of 2.9 in Vision Lines. The BCVA significantly improved (P < .05) in the groups of corneal graft and dressing. In the PCU subgroup (6 patients), the healing time of epithelial defect was significantly reduced (P < .05) in patients treated only with the mPRGF in comparison to those which mPRGF therapy was associated to the amniotic membrane. The IOP remained stable (P > .05) throughout the clinical follow-up time. No adverse events were reported after mPRGF use.The mPRGF is effective and safe as coadjuvant treatment in surgeries related with ocular surface disorders, being an alternative to the use of amniotic membrane. The mPRGF accelerates tissue regeneration after ocular surface surgery thus minimizing inflammation and fibrosis.

Figure 1

Preparation process of plasma rich in growth factors membranes (mPRGF). (A) Blood tube after centrifugation. (B) Coagulation of fibrin clot. (C) mPRGF on the former. (D) mPRGF obtained after conformation. (E) Membrane mounted on nitrocellulose disk.

Figure 2

Use of the mPRGF in persistent epithelial defects. (A) Intraoperative image of PED. (B) Epithelium debridement. (C) Placement of mPRGF on corneal surface. (D) Extending and trimming down of mPRGF. (E) Running suture of mPRGF to cornea with 10/0 nylon. (F) Therapeutic contact lens placement over mPRGF after surgery. mPRGF = plasma rich in growth factors membranes, PED = persistent epithelial defect.

Figure 3

mPRGF treatment after cataract surgery followed by deep anterior lamellar keratoplasty. (A) Leukoma secondary to herpes simplex virus and bacterial corneal abscess. (B) Corneal dissection until predescemet space. (C) Corneal donor button suture with 10/0 nylon and 360° conjunctival peritomy. (D) Application of conformed mPRGF to the ocular surface. (E) Placement of mPRGF inside the subconjunctival space. (F) Running suture of the mPRGF to the conjunctiva with vicryl 8/0. mPRGF = plasma rich in growth factors fibrin membrane.

Figure 4

BVCA (LogMAR) outcomes measured before and after mPRGF treatment in the different groups included in the study. ^∗Statistically significant differences (P < .05) before versus after treatment with mPRGF. BCVA = best corrected visual acuity, mPRGF = plasma rich in growth factors fibrin membrane.

Figure 5

Outcome variables in surgical subgroup PCU according to association with AMT. AMT = amniotic membrane transplantation, BCVA = best corrected visual acuity, HTED = healing time of the epithelial defect, ICT = inflammation control time, mPRGF = plasma rich in growth factors fibrin membrane, mPRGF AT = absorption time of mPRGF, PCU = persistent corneal ulcer. ∗P < .05.

Figure 6

Ocular trauma due to a central corneal metallic foreign body. (A) Corneal foreign body injury with maceration and central thinning. (B) First postoperative day after treatment with a central mPRGF cap and another mPRGF used as a dressing over the first. (C) OCT of anterior segment at first day postsurgery. Both mPRGFs used as a cap (arrow) and as a dressing (arrowheads) are observed. (D–I) Evolution after a second surgery (deep anterior lamellar keratoplasty): (D) Fifth day after surgery (E) Third week after surgery. (F) OCT of anterior segment in third week after surgery. (G) Third month postsurgery. (H) Fifth month after surgery. (I) Visante in the fifth month after surgery. mPRGF = plasma rich in growth factors fibrin membrane, OCT = Optical Coherence Tomography.