Platelet-rich Plasma May Hold Promise in Treating Severe Dry Eye
By Marguerite McDonald, MD, FACS
Recent work by Colombian researchers on the effects of injected platelet-rich plasma may hold promise for a new approach to treatment of severe dry eye.
Marcel Avila, MD, PhD, and his colleagues in Bogota, Colombia, conducted two studies on the effects of platelet-rich plasma in the treatment of severe dry eye. Both studies produced encouraging results that merit our attention and further study.
In the first study, four patients with severe lacrimal dysfunction and severe dry eye received 1 milliliter injections of platelet-rich plasma transcutaneously near the lacrimal gland in four treatment sessions that were spaced one week apart over 12 weeks. This study was interventional and did not include a control group. The patients were followed up for 12 weeks after the first injection.
Avila and his colleagues then followed up with a second, larger study with 30 patients. Like the first, this study involved injections of platelet-rich plasma, and also was a prospective, interventional study of patients with severe dry eye who had been diagnosed with Sjogren’s syndrome. However, in this study, patients were divided into two groups of 15 each. The first group received hyaluronic acid drops five times a day in addition to the plasma injections. A control group received only the hyaluronic acid drops five times a day.
Results of the studies were evaluated using measurements including a Schirmer test, ocular surface staining, corneal staining and tear break-up time (TBUT).
In both studies, the PRP injections brought clinically and statistically significant symptom relief and notable improvement in lacrimal production to the patients. In the second study, the intervention group showed improvements in all primary outcome measures when compared with the control group, including a reduction in corneal staining, increase in the mean Schirmer’s value, and an increase in TBUT. In addition, the treatment group had a mean 18-point reduction in their ocular surface disease index score, signifying a dramatic increase in ocular comfort and function.
The findings in these two studies may reflect an improvement in both the volume and the quality of tear components. This may also indicate improvement in meibomian gland function associated with paracrine regulation.
Taken together, the two studies appear to indicate that PRP injection is safe and effective in improving tear parameters as well as subjective parameters. In addition, the results were determined be superior to hyaluronic acid alone in the management of patients with severe dry eye.
Although measures of symptoms after treatment indicated that patients still had severe dry eye, patients reported greater comfort, particularly when reading or performing outdoor activities.
Hopefully, there will be additional studies of this intriguing treatment approach. Those studies should investigate the use of isolated growth factors and, potentially, autologous stems cells. In the meantime, the work that Avila and colleagues have done represent an important step in a unique but practical approach toward the regeneration of lacrimal function.
Marguerite McDonald, MD, FACS, with OCLI on Long Island, NY, is clinical professor of Ophthalmology at NYU Langone Medical Center, NY, and clinical professor of Ophthalmology at Tulane University Health Sciences Center, New Orleans, Louisiana.