Evaluation of the efficacy of platelet-rich plasma lysate in patients after urgent keratoplasty based on an analysis of changes in the protease-inhibitor balance of tears (pilot study)

Purpose: to estimate the effectiveness of platelet-rich plasma (PRP) lysate to reduce the activity of matrix metalloproteinases in tear fluid and prevent graft lysis in patients after urgent keratoplasty.

Material and methods. The study was carried out on 10 patients after urgent penetrating keratoplasty. Control group included 12 healthy adults (24 eyes). After surgery, patients received PRP lysate in subconjunctival injections and instillations. Tear fluid was collected using filter paper before the operation and on the 7th day after it. Concentrations of MMP-9 and TIMP-1 in tears were determined by ELISA. Clinical criterion for the corneal status in the early postoperative period was the area of transplant epithelization on the 7-th day after surgery.

Results. Concentrations of MMP-9 in tears in all patients before surgery were significantly higher than in healthy controls. Patients with repeat keratoplasty had higher MMP-9 concentration than ones before the first keratoplasty — 15.50 ± 1.54 ng/ml and 17.28 ± 0.47 ng/ml. Treatment with PRP lysate caused a statistically significant decrease of MMP-9 concentration in tears of patients after first keratoplasty. Patients with repeat keratoplasty demonstrated a tendency for decrease of MMP-9 concentration after treatment.

Conclusion. Timely decrease of MMP-9 activity in cornea after its function in the tissue remodeling is completed is a necessary condition for the successful corneal engraftment. PRP lysate contains a large amount of TIMP-1 and can be used for the prevention of keratolysis in urgent corneal surgery.

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