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The combination of an autologous fibrin membrane and platelet-rich plasma clot appears to be safe and effective for treating perforated corneal ulcers, a pilot study showed.
The approach sealed the perforations in all 11 patients included in the study, without any signs of inflammation or infection, according to Jorge Alió, MD, PhD, of Vissum Corporación Oftalmológica in Alicante, Spain, and colleagues.
And at the end of follow-up 90 days after the procedure, there were no relapses or additional perforations, the researchers reported online in JAMA Ophthalmology.
The procedure "is a safe and effective surgical alternative for the closure of corneal perforations," they wrote. "This technique can be considered as a temporary measure until the condition of the cornea permits definite intervention."
They added that its use deserves further study to confirm its place in clinical practice.
Corneal perforations can be caused by trauma or ulcerative disease and "constitute a major ophthalmic emergency necessitating the intervention of corneal surgeons because of the severity and major consequences, such as infection, severe anatomic distortion of the anterior segment of the eye, retinal detachment, phthisis bulbi, and total blindness," according to the researchers.
Various methods are used to treat them, including ocular adhesives, conjunctival flaps, heterologous amniotic membrane transplants, and corneal grafting.
Alió and colleagues explored another alternative -- the combination of a fibrin membrane and a platelet-rich plasma clot, which were both derived using 40 to 60 mL of each of the 11 patients' own blood before the operation. The patients, ranging in age from 23 to 82, had perforations stemming from severe corneal ulcerative diseases.
During the procedure, part of the fibrin membrane was attached to the conjunctiva using nylon stitches. The clot was then placed over the corneal perforation underneath the fibrin membrane, after which the membrane was attached to the rest of conjunctiva. At the end of the procedure, the researchers performed a temporal partial tarsorrhaphy.
The patients received systemic ciprofloxacin 750 mg every 12 hours for 5 days after the operation, as well as ibuprofen 800 mg every 8 hours for 3 days.
Follow-up lasted at least 3 months after the procedure.
The perforations were sealed in all patients, with the fibrin membrane disappearing after the first 3 to 5 days. Finger pressure revealed "acceptable levels of ocular tonus" for all of the patients from postoperative Day two.
None of the patients reported any pain, discomfort, or complications after the operation.
Seven of the patients ultimately underwent definite corneal grafting.
The researchers explained the role the platelet-rich plasma played in the recovery of the patients.
"Platelets play a central role in hemostasis, promoting coagulation in vascular injuries. At the same time, platelets constitute natural reservoirs of growth factors, cell adhesion molecules, and cytokines stored in their alpha granules," they wrote. "Between these growth and mitogenic factors are epidermal growth factors, platelet-derived growth factors, fibroblast growth factors, insulin-like growth factors, and transforming growth factors.
"They also contain important cell adhesion molecules, such as fibrin, fibronectin, and vitronectin, which enhance growth factor activities. The release of these molecules at the site of injury helps initiate and modulate wound healing, thus promoting tissue reparation in both soft and hard tissues.
"We assume that this formulation [used in the study] contains the proper growth factors of blood and platelets, although their concentration was not measured in this study," the investigators wrote.
The primary advantage for the studied approach was the use of autologous material, Alió and colleagues noted, although there is some downside.
"The main disadvantage of this technique would be the cost, especially when compared with the cost of cyanoacrylate glue," they added. "Specialized technicians are needed to prepare the autologous fibrin membrane and [platelet-rich plasma] clot, and the process requires at least 2 hours of laboratory work."
The study was supported in part by a grant from the Spanish Ministry of Science and Innovation.
The authors reported that they had no conflicts of interest.
Todd Neale
Senior Staff Writer
Todd Neale, MedPage Today Staff Writer, got his start in journalism at Audubon Magazine and made a stop in directory publishing before landing at MedPage Today. He received a B.S. in biology from the University of Massachusetts Amherst and an M.A. in journalism from the Science, Health, and Environmental Reporting program at New York University.
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