September 2019

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Presentation Spotlight
IOP regulation using autologous platelet treatment


by Stefanie Petrou Binder, MD EyeWorld Contributing Writer


OCT photo taken after PRP injection to treat hypotony in the eye of a patient after a MIGS procedure

OCT image showing PRP healing effect after a microperforation
Source (all): Omneya Al-Rahman, MD

 

Eye platelet rich plasma (E-PRP) can lead to dramatic decreases in IOP in patients of different ages, genders, and with ocular hypotension of various etiologies, according to a presentation given at the 23rd European Society of Cataract and Refractive Surgeons (ESCRS) Winter Meeting.
Data indicate that platelet rich plasma can be a reliable and effective therapeutic tool to enhance epithelial wound healing in ocular surface disease. Blood derived products have demonstrated their capacity to enhance and stimulate the regeneration of different tissues. Eye platelet rich plasma provides a higher concentration of essential growth factors and cell adhesion molecules by concentrating platelets in a small volume of plasma as compared to autologous serum, the latter being used widely in ophthalmology for epithelial wound healing of the cornea.1

Autologous platelet treatment

New evidence suggests that autologous platelet rich plasma injection into the anterior chamber may offer a new, promising technique for the treatment of progressive and severe ocular hypotony. E-PRP is prepared by means of a simple procedure involving collecting blood from the patient, separating the platelets through centrifugation, and extracting platelet rich growth factor for 3–6 mg of PRP.
“PRP is a blood derived product that enhances wound healing, stimulates tissue regeneration, and allows better cell adhesion. E-PRP is safe to use in the anterior chamber,” said Omneya Al-Rahman, MD, said, in her presentation “Extreme ocular hypotension treated with platelet rich plasma.” “Autologous blood has no risk of infection, no allergic reactions, or other side effects. It is convenient, quick, and noninvasive. PRP is natural, incurring no sense of violation from foreign body effect. And most importantly, it is effective in lowering IOP, with superior and long-lasting effects through the use of growth factors.”

Case studies

Dr. Al-Rahman presented four case studies in which PRP injection was effective in lowering IOP. The first case involved a 55-year-old man with Axenfeld-Rieger syndrome. Due to elevated IOP that was resistant to all anti-glaucoma eye drops, the patient underwent glaucoma surgery with express microvalve implantation and mitomycin-C enhancement. Hypotony ensued as a result of scleral atrophy, overfiltration, and a leaky conjunctival bleb, due to anterior segment dysgenesis.
Dr. Al-Rahman injected 0.3 ml autologous PRP intracamerally in an attempt to close the filtering area of the sclera. Slit lamp and anterior segment OCT showed a PRP clot filling the anterior chamber. Nd:YAG laser was performed (3–4 mJ/pulse, for 2 msec) 2 weeks later to dissolve the remnants of E-PRP stuck in the anterior chamber periphery. The patient’s final mean IOP was 14 mm Hg.
“The enhancing effect is attributed to platelet release growth factors: platelet derived growth factor (PDGF), vascular endothelial growth factor (VEGF), transforming growth factor beta, keratinocyte growth factor, epidermal growth factor, and fibroblast growth factor,” she said.
PRP was also applied in the eye of a 75-year-old female patient with a traumatic corneal opacity that led to blindness and a cosmetically deformed eye. The patient underwent keratopigmentation, with hypotony resulting from a microperforation due to thin cornea.
PRP was injected in an attempt to close the corneal perforation internally. The treatment helped to regulate the patient’s IOP, resulting in a final mean IOP of 13 mm Hg. Again, as in the previous case, Nd:YAG laser was successfully carried out 12 days after the treatment to dissolve PRP remnants in the anterior chamber.
Another case profiled a 7-year-old girl with juvenile rheumatoid arthritis and a cyclitic membrane that was revealed on both slit lamp and ultrasound examinations. Hypotony is an important complication in uveitis with onset at a young age. The patient had a dramatic decrease in IOP that was not treatable by any traditional methods for 2 months. Dr. Al-Rahman injected the patient with E-PRP following the same regimen, to block the angle, reducing IOP to 12 mm Hg. Nd:YAG laser removed PRP remnants in the anterior chamber and there was a complete removal of the cyclitic membrane.
The last case presented by Dr. Al-Rahman described an 88-year-old female patient who presented with ocular hypotension, macular edema, and elevated IOP following a nonfunctioning microvalve, resistant to all attempts at management. E-PRP was injected to block the iridodialysis and the outcome was a final mean IOP of 16 mm Hg.
“PRP is safe and effective compared to traditional ways of hypotony management like contact lenses, silicone oil injection in the AC, viscoelastic injection in the AC, and transconjunctival flap suturing. Success is in your blood,” she said.

About the doctor

Omneya Al-Rahman, MD

VISSUM Institute
Alicante, Spain

Reference

1. Alio JL, et al. The role of “eye platelet rich plasma” (E-PRP) for wound healing in ophthalmology. Curr Pharm Biotechnol. 2012;13:1257–65.

Relevant financial interests

Al-Rahman
: None

Contact information

Al-Rahman: omneyaabdalrahman@gmail.com

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