Topical platelet rich plasma eye drops (e-PRP) in the treatment of severe ocular surface diseases

Session Details

Session Title: Cornea: Medical

Session Date/Time: Tuesday 10/10/2017 | 08:00-10:30

Paper Time: 09:48

Venue: Room 3.6

First Author: : L.Espandar USA

Co Author(s): :    L. To   F. Bonilla Escobar   V. Jhanji              

Abstract Details

Purpose:

Ocular surface disease is a significant burden to patients. Symptoms include eye pain, light sensitivity, and low quality of vision. The signs appear on exam as conjunctival injection, punctate epithelial erosions (PEE), low tear film break-up time and Schirmer scores. Severe disease is defined by the presence of both debilitating symptoms and significant exam findings. Despite available therapies, some patients remain refractory to treatment with artificial tears, topical immunomodulators such as cyclosporine, and steroids. Autologous platelet-rich-plasma (e-PRP) drops are a novel approach to treatment, and can deliver concentrated growth factors and cytokines to promote wound healing and modulate inflammation.

Setting:

UPMC Eye Center, Pittsburgh, PA, USA

Methods:

Case series of patients with severe ocular surface diseases who received e-PRP treatment (8 weeks, Q6h) from June 2015 to June 2016. Data from pre-treatment (P0) and 1-month (T1), 6-month (T2), and 12-month (T3) visits following treatment was collected. Best corrected visual acuity (BCVA) reported as logMAR for analysis. Missing BCVAs were imputed with the last available. Meibomian gland dysfunction (MGD), PEE, conjunctival injection, epithelial defect size, corneal neovascularization (KNV), corneal opacity, and subjective improvement were recorded. Impact of disease was quantified by the Surface Index (SI), an average of MGD, PEE, and conjunctival injection scores.

Results:

Thirty-one eyes (18 patients) were included. Subjective improvement was reported in 48.4% at T1. Differences were statistically significant between mean baseline BCVA (0.61; 95% CI=0.41-0.80), compared to T1 (0.51; 95% CI=0.29-0.72; p=0.04), T2 (0.49; 95%CI=0.28-0.70; p=0.004), and T3 (0.48; 95% CI=0.27-0.69; p=0.01). Mean epithelial defect at P0 was 52%±48% and 10%±7% at T1 (p=0.13). KNV was observed in 25.8% at P0 and T1, T2:19.3% and T3:6.4% (p=1.0). Corneal opacity at P0 was 29.03%, T1:18.52%, T2:14.29%, and T3:38.46% (p=0.33). Average SI at P0 was 1.08±0.75, T1:0.85±0.83, T2:0.98±0.84, and T3:0.61±0.54, without significant differences between P0-T1 (p=0.27).

Conclusions:

In our study, a single round of e-PRP treatment can lead to improvements in both symptoms and visual acuity. Nearly half of the patients reported improvement in symptoms one month following treatment. The improvement in visual acuity was sustained up to 12 months following treatment completion. Other signs of surface inflammation, including epithelial defect size, presence of KNV, corneal opacity, and surface index, appear to trend towards improvement, but are limited by study power. A larger cohort in future studies may elucidate significance, and would allow us to investigate potential differences in treatment response amongst each disease subgroup.

Financial Disclosure:

NONE