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Abstract：
BACKGROUND: The aim of this study was to evaluate the use of highly concentrated platelet-rich plasma (PRP) subconjunctival injections, in combination with eye drops (eye PRP, or E-PRP), in treating dry eye disease (DED) and the use of platelet-rich fibrin (PRF) membrane in treating corneal burns and neurotrophic ulcers for the restoration of the homeostasis of the tear film and the morphology and function of the cornea.
METHODS: We studied 16 patients (n=32 eyes) with severe DED. The disease was graded as severe according to the Oxford Grading Scale. There were 12 males (75%) and four females (25%) with a mean age of 56 years; these patients were treated with monotherapy, which involved a single subconjunctival injection of 0.2-0.3 mL of PRP prepared from autologous blood, followed by application of autologous PRP eye drops four times a day for 15 days between September 2019 and December 2020 in the same geographic area. All patients gave written informed consent before undergoing the outlined treatment protocol. We evaluated best corrected visual acuity (BCVA), Schirmer test score, tear film breakup time (TBUT) and corneal staining with fluorescein (Oxford Grading Scale) before and after six to eight weeks of treatment. Subjective normalization was defined by a decrease in the Ocular Surface Disease Index (OSDI) score to 10 or less, an objective normalization of the TBUT to five to six seconds, improvement in the Schirmer test score and Oxford grading and the BCVA gain of at least one line in the vision chart (Snellen chart). Furthermore, we report on the results from different variants of platelet concentrate-based treatments in five cases of corneal diseases: neurotrophic ulcers and corneal burns due to different causes (e.g., chemical burns) using E-PRP and PRF membrane with regard to normalization of morphology and function.
RESULTS: The OSDI score decreased to normalization in 75% of the patients (p=6.545 × 10-15). TBUT was restored significantly in 20 of 32 eyes from 2.78±0.55 to 5.43±0.71 (p=1.612 × 10-24). The Schirmer test score showed an improvement from 4.46±0.67 to 10.28±1.18 (p=3.411 × 10-29), and BCVA improved by 43.75%, from 0.15±0.19 to 0.09±0.16 (logMAR, p=0.2331). Oxford grading changed to Scale I in 75% and Scale 0 in 25% of the patients. No complications or adverse reactions occurred in the five cases of corneal injuries. We observed a restoration of the morphology and function of the cornea with PRP injections or PRF+PRP application in 7-12 days, depending on the severity of the initial finding.
CONCLUSIONS: PRP treatment is a new approach in ophthalmology with impressive results. Although patients show good compliance and acceptance of the treatment protocol, studies with larger sample sizes are needed to confirm and optimize its use.
METHODS: We studied 16 patients (n=32 eyes) with severe DED. The disease was graded as severe according to the Oxford Grading Scale. There were 12 males (75%) and four females (25%) with a mean age of 56 years; these patients were treated with monotherapy, which involved a single subconjunctival injection of 0.2-0.3 mL of PRP prepared from autologous blood, followed by application of autologous PRP eye drops four times a day for 15 days between September 2019 and December 2020 in the same geographic area. All patients gave written informed consent before undergoing the outlined treatment protocol. We evaluated best corrected visual acuity (BCVA), Schirmer test score, tear film breakup time (TBUT) and corneal staining with fluorescein (Oxford Grading Scale) before and after six to eight weeks of treatment. Subjective normalization was defined by a decrease in the Ocular Surface Disease Index (OSDI) score to 10 or less, an objective normalization of the TBUT to five to six seconds, improvement in the Schirmer test score and Oxford grading and the BCVA gain of at least one line in the vision chart (Snellen chart). Furthermore, we report on the results from different variants of platelet concentrate-based treatments in five cases of corneal diseases: neurotrophic ulcers and corneal burns due to different causes (e.g., chemical burns) using E-PRP and PRF membrane with regard to normalization of morphology and function.
RESULTS: The OSDI score decreased to normalization in 75% of the patients (p=6.545 × 10-15). TBUT was restored significantly in 20 of 32 eyes from 2.78±0.55 to 5.43±0.71 (p=1.612 × 10-24). The Schirmer test score showed an improvement from 4.46±0.67 to 10.28±1.18 (p=3.411 × 10-29), and BCVA improved by 43.75%, from 0.15±0.19 to 0.09±0.16 (logMAR, p=0.2331). Oxford grading changed to Scale I in 75% and Scale 0 in 25% of the patients. No complications or adverse reactions occurred in the five cases of corneal injuries. We observed a restoration of the morphology and function of the cornea with PRP injections or PRF+PRP application in 7-12 days, depending on the severity of the initial finding.
CONCLUSIONS: PRP treatment is a new approach in ophthalmology with impressive results. Although patients show good compliance and acceptance of the treatment protocol, studies with larger sample sizes are needed to confirm and optimize its use.
摘要：
背景：这项研究的目的是评估高度浓缩的富血小板血浆（PRP）结膜下注射的使用，与眼药水（眼药水，或E-PRP)，在治疗干眼病（DED）和使用富血小板纤维蛋白（PRF）膜治疗角膜烧伤和神经营养性溃疡，以恢复泪膜的稳态以及角膜的形态和功能。
方法：我们研究了16例重度DED患者（n=32眼）。根据牛津分级量表将该疾病分级为严重。有12名男性（75％）和4名女性（25％），平均年龄为56岁;这些患者接受单一疗法治疗，其中包括一次结膜下注射由自体血制备的0.2-0.3mLPRP，随后在2019年9月至2020年12月期间，在同一地理区域每天四次应用自体PRP滴眼液，持续15天。所有患者在接受概述的治疗方案之前都给出了书面知情同意书。我们评估了最佳矫正视力（BCVA），Schirmer考试成绩,治疗前六至八周的泪膜破裂时间（TBUT）和荧光素（牛津分级量表）的角膜染色。主观标准化定义为眼表疾病指数（OSDI）评分降低至10或更低，将TBUT的客观归一化为5到6秒，Schirmer考试成绩和Oxford评分的提高以及视力图表(Snellen图表)中至少一条线的BCVA增益。此外，我们报告了5例角膜疾病中基于血小板浓缩物的不同变体治疗的结果：由于不同原因引起的神经营养性溃疡和角膜烧伤（例如，化学烧伤）使用E-PRP和PRF膜进行形态学和功能正常化。
结果：75％的患者OSDI评分降低至正常化（p=6.545×10-15）。32只眼中有20只眼的TBUT从2.78±0.55恢复到5.43±0.71（p=1.612×10-24）。Schirmer测试得分从4.46±0.67提高到10.28±1.18（p=3.411×10-29），BCVA提高了43.75%，从0.15±0.19到0.09±0.16(logMAR，p=0.2331）。75％的Oxford分级更改为I级，25％的患者更改为0级。5例角膜损伤均未发生并发症或不良反应。我们观察到通过PRP注射或PRF+PRP应用在7-12天内角膜的形态和功能的恢复。取决于最初发现的严重程度。
结论：PRP治疗是眼科的一种新方法，效果令人印象深刻。尽管患者对治疗方案表现出良好的依从性和接受度，需要更大样本量的研究来确认和优化其使用。
方法：我们研究了16例重度DED患者（n=32眼）。根据牛津分级量表将该疾病分级为严重。有12名男性（75％）和4名女性（25％），平均年龄为56岁;这些患者接受单一疗法治疗，其中包括一次结膜下注射由自体血制备的0.2-0.3mLPRP，随后在2019年9月至2020年12月期间，在同一地理区域每天四次应用自体PRP滴眼液，持续15天。所有患者在接受概述的治疗方案之前都给出了书面知情同意书。我们评估了最佳矫正视力（BCVA），Schirmer考试成绩,治疗前六至八周的泪膜破裂时间（TBUT）和荧光素（牛津分级量表）的角膜染色。主观标准化定义为眼表疾病指数（OSDI）评分降低至10或更低，将TBUT的客观归一化为5到6秒，Schirmer考试成绩和Oxford评分的提高以及视力图表(Snellen图表)中至少一条线的BCVA增益。此外，我们报告了5例角膜疾病中基于血小板浓缩物的不同变体治疗的结果：由于不同原因引起的神经营养性溃疡和角膜烧伤（例如，化学烧伤）使用E-PRP和PRF膜进行形态学和功能正常化。
结果：75％的患者OSDI评分降低至正常化（p=6.545×10-15）。32只眼中有20只眼的TBUT从2.78±0.55恢复到5.43±0.71（p=1.612×10-24）。Schirmer测试得分从4.46±0.67提高到10.28±1.18（p=3.411×10-29），BCVA提高了43.75%，从0.15±0.19到0.09±0.16(logMAR，p=0.2331）。75％的Oxford分级更改为I级，25％的患者更改为0级。5例角膜损伤均未发生并发症或不良反应。我们观察到通过PRP注射或PRF+PRP应用在7-12天内角膜的形态和功能的恢复。取决于最初发现的严重程度。
结论：PRP治疗是眼科的一种新方法，效果令人印象深刻。尽管患者对治疗方案表现出良好的依从性和接受度，需要更大样本量的研究来确认和优化其使用。
