Experience of using a thrombofibrin clot of plateletrich plasma in ulcerative lesions of the cornea

Purpose: to study the effectiveness of the use of thrombofibrin clot of platelet-rich plasma (PRP) in patients with corneal ulcers. Material and methods. A clinical study, conducted by the Department of Traumatology and Reconstructive Surgery of Helmholtz National Medical Research Center of Eye Diseases, involved 20 patients, aged from 22 to 82, with corneal ulcers of inflammatory and burn genesis more than 100 microns deep. All patients got coated with a thrombofibrin PRP clot from autologous blood. Prior to the study, all patients received standard treatment for 2 weeks to 3 months, including multiple amniotic membrane coating, with no effect. The thrombofibrin clot was produced by the Scientific Department of Biotechnology and Transfusiology of the N.V. Sklifosovsky Research Institute for Emergency Medicine. The ready clot was placed on the surface of the cornea and covered with an amniotic membrane. The membrane was fixed to the episclera along the border of the limb with a circular suture, whereupon autologous serum was injected along the limb in 4 quadrants, to be followed by temporary lateral blepharography. Results. On the 2nd day following the procedure, the patients noted a decrease in lacrimation and pain in the operated eye. As shown by optical coherence tomography, the average depth of the corneal ulcer at the beginning of the study in all patients was 129 ± 28.5 microns. On the 5^th day, the depth lowered to an average of 71 ± 32.6 microns, and on the 10^th day, to 23.3 ± 15.1 microns. In 7 patients (35%), complete healing of the defect was observed on the 15^th day, while in 9 patients (45%) it was stated between the 16^th and the 20^th day. Thus, the average time of healing of the ulcer with complete epithelization occurred was 15 days. In four patients with the consequences of severe burns (20%), the ulcer did not heal due to extensive damage to the limbal zone. Conclusion. The use of a thrombofibrin PRP clot in combination with amniotic membrane transplantation allows achieving a stable and fairly rapid healing of corneal ulcers of various origins. However, this method is ineffective in patients with limbal cell insufficiency, severe burns and extensive damage to the limbal zone. In such cases, it is advisable to use more radical surgical methods, such as buccal or limbal cell transplantation, or allolimbal transplantation.

1. Jani E.V., Pozdnjakova V.V., Arestova N.N., et al. Corneal trophic ulcer. Clinical recommendations of the Ministry of Health of the Russian Federation. 2017 (in Russian). Available at: https://www.oofd72.ru/upload/documents/4-YAzva-rogovitsy-troficheskaya-KR_99_YAzva_rogovicy_troficheskaya.pdf

2. Mlynarek R.A., Kuhn A.W., Bedi A. Platelet-Rich Plasma (PRP) in Orthopedic Sports Medicine. American Journal of Orthopedics (Belle Mead NJ). Jul-Aug 2016; 45 (5): 290-326. PMID: 27552452

3. Martinez-Martinez A., Ruiz-Santiago F., Garcia-Espinosa J. Platelet-rich plasma: myth or reality? Radiologia. Nov-Dec 2018; 60 (6): 465—75. doi: 10.1016/j.rx.2018.08.006

4. Foster T.E., Puskas B.L., Mandelbaum B.R., Gerhardt M.B., Rodeo S.A. Plateletrich plasma: from basic science to clinical applications. Am. J. Sports Med. 2009; 37 (11): 2259-72. doi: 10.1177/0363546509349921

5. Intini G. The use of platelet-rich plasma in bone reconstruction therapy. Biomaterials. 2009; 30 (28): 4956-66. doi: 10.1016/j.biomaterials.2009.05.055

6. Arnalich F., Rodriguez A.E., Luque-Rio A., Alio J.L. Solid platelet rich plasma in corneal surgery. Ophthalmology and Therapy. 2016 Jun; 5 (1): 31-45. doi: 10.1007/s40123-016-0051-9

7. Makarov M.S., Kobzeva E.N., Vysochin I.V., Borovkova N.V., Khvatov V.B. Morphofunctional analysis of human platelets using vital staining. Bjulleten' jeksperimental'noj biologii i mediciny. 2013; 156 (9): 391 (in Russian).

8. Konstantinidis A., Hero M., Nanos P., Panos G.D. Efficacy of autologous platelets in macular hole surgery. Clin. Ophthalmol. 2013,7:745-50. doi: 10.2147/OPTHS44440

9. Loshkareva A.O., Majchuk D.Ju. The use of platelet-rich plasma in patients with chronic corneal erosions. Sovremennye tehnologii v oftal'mologii. 2016; 4: 131-2 (in Russian).

10. Filatova I.A., Shemetov S.A., Pavlenko Ju.A., Fedoseeva E.V., Borovkova N.V., Ponomarev I.N. The use of platelet-rich plasma lysate as a stage of preoperative preparation of patients with post-traumatic scarring of the eyelid tissues. Tochka zrenija. Vostok-Zapad. 2020; 3: 55-7 (in Russian). https://doi.org/10.25276/2410-1257-2020-3-55-57

11. Borovkova N.V., Filatova I.A., Chentsova E.V., et al. Efficacy of platelet-rich plasma lysate in patients with corneal erosion or post-traumatic scarring of the tissues of the eyelids. Russian ophthalmological journal. 2020; 13 (3): 8-14 (In Russian). https://doi.org/10.21516/2072-0076-2020-13-3-8-14

12. Alio J.L., Rodriguez A.E., Wrobel Dudzinska D. Eye platelet-rich plasma in the treatment of ocular surface disorders. Current Opinion in Ophthalmology. 2015 Jul; 26 (4): 325-32. doi:10.1097/ICU.0000000000000169

13. Fedoseeva E.V., Chentsova E.V., Borovkova N.V., et al. A case of autologous thrombofibrin clot use in a patient with post-burn persistent corneal erosion. Transplantologiya. The Russian Journal of Transplantation. 2019; 11 (2): 150-7 (in Russian). https://doi.org/10.23873/2074-0506-2019-11-2-150-157

14. Borovkova N.V., Makarov M.S., Ponomarev I.N., et al. Method for obtaining platelet-rich plasma and method for obtaining thrombofibrin gel or serum clot containing growth factors from unstabilized venous blood. RF Patent # 0002717448; 2020 (in Russian).

15. Chentsova E.V., Fedoseeva E.V., Ponomarev I.N., Borovkova N.V. Method of treatment of corneal defects with autologous thrombofibrin clot. RF Patent #2699206; 2019 (in Russian).

16. Egorova N.S., Chentsova E.V., Borovkova N.V., Makarov M.S., Storozheva M.V. Experimental repair of deep corneal defects using a bio-construct comprising a collagen type I matrix loaded with buccal epithelial cells. Transplantologiya. The Russian Journal of Transplantation. 2017; 9 (3): 226-35 (in Russian). https://doi.org/10.23873/2074-0506-2017-9-3-226-235

17. Chentsova E.V., Makarov P.V., Khazamova A.I. A method for the surgical treatment of corneal defects of various origins. RF Patent # 2607163; 2017 (in Russian).