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Zastosowanie osocza bogatopłytkowego w leczeniu neurotroficznych owrzodzeń rogówki
Autologous Platelet Rich-Plasma Eye Drops in Neurotrophic Ulcers Treatment
Dominika Wróbel-Dudzińska 1 , Ewa Suchodoła-Ratajewicz 2 , Ewa Kosior-Jarecka 1 , Beata Rymgayłło-Jankowska 1 , Agnieszka Ćwiklińska-Haszcz 1 , Tomasz Żarnowski 1
1 Klinika Diagnostyki i Mikrochirurgii Jaskry Uniwersytetu Medycznego w Lublinie
Kierownik: prof. dr hab. n. med. Tomasz Żarnowski
2 Klinika Okulistyki Ogólnej Uniwersytetu Medycznego w Lublinie
Kierownik: prof. dr hab. n. med. Robert Rejdak
Summary: Purpose: To investigate the efficacy of autologous platelet-rich plasma eye drops in neurotrophic kerathopathy. Platelet-rich plasma provides higher concentration of essential growth factors and cell adhesion molecules by concentrating platelets in a small volume of plasma as compared with autologous serum. These biologically active agents have a major role in wound healing and regeneration process.
Setting: The analysis included 17 patients with neurotrophic ulcers treated with platelet-rich plasma in the Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Poland.
Methods: The main diagnosis were neurotrophic ulcers (stage 2 or 3 in Mackie classification) in 10 cases after herpes simplex and varicella zoster infections and 7 cases with post-surgical damage of the fifth cranial nerve because of intracranial tumors. Patients used autologous platelet-rich plasma drops 5 times a day for approximately 3 months, artificial tears without preservatives and ointment with vitamin A for the night. Best corrected visual acuity, subjective symptoms and changes in staining of the anterior segment with fluorescein, conjunctival hyperemia and corneal thickness using the Anterior Segment Optical Coherence Tomography were assessed.
Results: Mean best corrected visual acuity before treatment was 0.11 ± 0.14, after treatment 0.30 ± 0.27(p = 0.001). There has been improvement in reduction of the subjective symptoms in all patients. 14 patients (82%) had completed healed ulcer, 2 patients (12%) showed significant clinical improvement. The treatment time was about 3 months. In one case no change was observed and amniotic membrane transplantation was performed. Decrease/disappearance of corneal fluorescein staining was noticed in 82%, hyperaemia in 93%. Mean corneal thickness at the thinnest point was 302.30 ± 125.17 µm before treatment and 397.50 ± 98.83 µm after treatment (p = 0.017). The inhibition of the progression of corneal thinning was observed in 16 patients (94%). None of the patients reported general or local side-effects of the therapy.
Conclusions: Autologous platelet-rich plasma seems to be effective therapy in majority of the cases with neurotrophic keratopathy. Platelet-rich plasma not only stopped the progression of corneal thinning but also enhance regeneration process.
Słowa kluczowe: osocze bogatopłytkowe, neurotroficzne owrzodzenia, optyczna koherentna tomografia przedniego odcinka (AS-OCT).
Keywords: autologous platelet-rich plasma, neurotrophic ulcer, Anterior Segment Optical Coherence Tomography (AS-OCT).