Novel Procedure Seals Corneal Perforations

A combination of an autologous fibrin membrane and platelet-rich plasma (PRP) appears to be safe and effective for treating perforated corneal ulcers, according to a new study.

Researchers at Vissum Corporación Oftalmológica (Alicante, Spain) conducted a study involving 11 patients to evaluate the use of autologous eye platelet-rich plasma (E-PRP) in combination with an autologous fibrin membrane as a surgical alternative for wound closure in perforated corneal ulcers; both the fibrin membrane and the E-PRP clot were prepared with the patient's own blood before the operation. Nylon stitches were used to fixate the fibrin membrane to the conjunctiva, and the E-PRP clot was placed over the corneal perforation, underneath the fibrin membrane; a temporal partial tarsorrhaphy was performed at the end of the procedure.

The results showed that in all cases the corneal perforation was sealed, with the fibrin membrane present over the corneal surface for the first 3-5 days, and then gradually disappearing. No evidence of infection or inflammation was detected. Digital tonometry confirmed acceptable levels of ocular tonus in all cases from day 2 after the operation. No patients reported pain, discomfort, or other symptoms, and no complications were observed. After three months' follow-up, there was no evidence of relapses or perforations. Corneal grafting was eventually performed in 7 of the 11 cases. The study was published online on April 4, 2013, in JAMA Ophthalmology.

“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,” said lead author Jorge Alió, MD, PhD. “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,” concluded Dr. Alió and colleagues. “We assume that this formulation contains the proper growth factors of blood and platelets, although their concentration was not measured in this study.”

Corneal perforations can be caused by trauma or ulcerative disease and constitute a major ophthalmic emergency necessitating the intervention of corneal surgeons. Major consequences of the perforation following such as infection include severe anatomic distortion of the anterior segment of the eye, retinal detachment, phthisis bulbi, and total blindness.

Related Links:
Vissum Corporación Oftalmológica