August 2007

 

OPHTHALMOLOGY NEWS

 

Effective to treat dormant corneal ulcers


by Matt Young EyeWorld Contributing Editor

   

The blank keratopathy slide shows severe drying and subsequent calcification in a patient with Sjogren's syndrome secondary to rheumatoid arthritis. Autologous serum has demonstrated efficacy in treating everything from dry eye to ocular surface disease, but autologous PRP may be an even better option in some cases.

Source: John Sheppard, M.D.

Use of platelet-rich plasma compared with use of autologous serum

Over the years, autologous serum has demonstrated efficacy in treating everything from dry eye to severe ocular surface disease. The list of its potential uses shows no sign of remaining static. In a new study, a kissing cousin—autologous platelet-rich plasma (PRP)—has shown to be effective in treating dormant corneal ulcers. “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,” wrote lead study author Jorge L. Aliу, M.D., Ph.D., Department of Cornea and Refractive Surgery, VISSUM, Instituto Oftalmologico de Alicante, Spain. The study was recently published in the online version of Ophthalmology.

A better treatment?

Until this study, autologous PRP was likely never used for the treatment of dormant corneal ulcers, the investigators noted. Yet the treatment has been within patients all this time. It is a combination of both platelets and plasma, both of which come from the patient’s own blood, Dr. Aliу noted. Autologous PRP concentrates the platelets via centrifugation, he reported. To prepare a clot, plasma is dissolved in a calcium ion solution, he reported. This creates a clot induced by activation of the platelets, he wrote. Yet many factors contribute to its advantages. According to the study investigators, autologous PRP requires minimal levels of autologous blood, simplified equipment, has a high concentration of growth factors, does not require bovine thrombin, and does not risk transmitting disease. In this study, autologous PRP was used to treat patients unresponsive to conventional treatment. Forty eyes of 38 patients underwent treatment. They were divided into two groups. In the first group, 26 eyes were treated with topical eye drops comprised of the plasma. Twelve of these eyes were neurotrophic, nine were herpetic, and five were immunological ulcers.

In the second group, 14 eyes were treated surgically with a solid clot of plasma as well as amniotic membrane transplantation in either perforated corneas or those in which perforation was imminent. In the first group, 13 eyes healed, 11 improved significantly, and two demonstrated no change. In the second group, 10 eyes healed, and four eyes improved significantly. “Autologous platelet-rich plasma has been shown to be a reliable and efficient procedure to restore the corneal epithelial surface in patients with dormant corneal ulcers,” Dr. Aliу wrote. One reason for this is because it’s the only product available that has a high number of growth factors, Dr. Aliу noted. “The fact that platelets secrete growth factors and active metabolites means that their applied use can have a positive influence in clinical situations requiring rapid healing and tissue regeneration,” Dr. Aliу wrote. “As concentrated platelets contain huge reservoirs of growth and wound-healing factors, they may represent a significant therapeutic tool in chronic corneal ulcerative processes.” It’s understandable that autologous PRP would be effective, as it has already been effective in other areas of medicine such as reconstructive surgery and orthopedics. Over time, the methods of obtaining the plasma have also become much simpler. Still, larger studies are needed to determine if the plasma ultimately is a better treatment option than more conventional measures.

The serum-PRP difference

In a recent issue of Ophthalmic Research, Dr. Aliу eloquently explained the difference between autologous serum and PRP. “The main difference between PRP and serum is the presence of platelets in the former and, due to this fact, there is a prolonged release of growth factors,” Dr. Aliу reported. He added, “PRP should be considered the product of choice in cases of severe dry eye where the presence of growth factors acting for longer periods of time is more beneficial.” Given Dr. Aliу’s successful use of PRP for both corneal ulcers and dry eye, other ophthalmologists may find PRP to be their autologous choice in the future. But autologous serum itself continues to have many fans. Walter Sekundo, M.D., Eye Clinic of the Gutenberg University, Mainz, Germany, said he uses autologous serum “constantly.”

The serum is useful for chemical burns, cases of stem cell deficiency, corneal ulcers that epithelialize poorly, keratoplasty, dry eye, and PTK to promote epithelialization and reduce pain. “I have never seen any adverse reaction to serum,” Dr. Sekundo said. “It is very well tolerated.” Dr. Sekundo said the University of Mainz is fortunate to have a license to produce and dispense autologous serum drops—and it is unique in Germany in that sense, he said—but the serum can also be produced in-house for personal clinical usage. “If you really need it for your own purposes, you draw blood, you centrifuge, and within 10 minutes you’ve got it,” Dr. Sekundo said. He said when he was affiliated with a previous university, he would make three bottles of autologous serum when needed: one for the same day, one refrigerated for day two, and one frozen for day three. Then blood would be drawn again, and this would ensure the sterility of the serum. “Autologous serum has a whole bunch of growth factors,” Dr. Sekundo said. “That is basically why it’s so helpful.”

Considering autologous PRP yields an even stronger dose of growth factors, ophthalmologists may become more familiar with the term “autologous PRP” than “serum” in the future.

Editors’ note: Dr. Alio has no financial interests related to his study. Dr. Sekundo has no financial interests related to his comments.

Contact Information

Aliу: 34-6-515-4062, jlalio@vissum.com

Sekundo: +49 (0) 61 31/17-5445, sekundo@augen.klinik.uni-mainz.de

Effective to treat dormant corneal ulcers Effective to treat dormant corneal ulcers
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