Usage of a new method of treatment of persistent corneal defects of various genesis

Abstract

Purpose. The aim of the work is to compare the time of epithelization and the change in the thickness of the cornea in the treatment of erosions after corneal burns of 2–3 degrees and ulcers after keratitis with preserved amnion and amnion saturated with autologous PRP lysate. Materials and methods. To compare the effectiveness of preserved amnion and lysate-soaked PRP, 2 groups of patients were identified: the main group (amnion saturated with lysate PRP) and the comparison group (amnion without lysate PRP). Each group included patients with erosions after recent burns with an average area of 60 % of the cornea and ulcers after keratitis with a corneal thickness at the bottom of the ulcer of 382 microns in the experimental group and 393 microns in the comparison group. In the comparison group, ulcers were treated by covering the cornea with an amniotic membrane for 7–14 days, after which the amnion was removed and the condition of the cornea was monitored. An amniotic membrane saturated with PRP lysate was used in the experimental group. PRP lysate was made from autologous blood of patients in the laboratory of cell transplantation and immunotyping of the N.V. Sklifosovsky Research Institute of Emergency Medicine using a patented technology. To do this, platelet-rich plasma (PRP) with a platelet content of over 1000 thousand/ml was isolated from the blood of donors, which was then frozen at -80 °C and thawed at 0–4 °C in order to destroy cell membranes. Assessment of the condition of the cornea was carried out using clinical and instrumental studies, including biomicroscopy with fluorescein staining, photoregistration and OCT on the Heidelberg Engineering “OCT Spectralis” apparatus. Results. The use of an amniotic membrane saturated with PRP lysate led to epithelialization of erosions after recent burns in 1.3 months and a decrease in corneal edema by 247 microns, epithelialization of ulcers after keratitis in 1.3 months and an increase in the thickness of the cornea at the bottom of the ulcer by 62.5 microns. Treatment with conventional preserved amnion took 1.8 months before complete epithelization in recent burns with a decrease in corneal stroma edema by 193 microns, and epithelization of ulcers after keratitis required 1.6 months and ended with an increase in the thickness of the cornea at the site of the ulcer by 42 microns. Conclusion. The study showed that the presented method of treating erosions and ulcers of the cornea of various genesis using an amniotic membrane saturated with autologous PRP lysate allows achieving complete and persistent epithelialization in a shorter time and with fewer amnion coatings, unlike the comparison group. At the same time, patients do not need additional conservative treatment of epitheliopathies.

Keywords

• amnion
• platelet-rich plasma
• corneal erosion
• corneal ulcers
• eye burns
• platelet lysate
• growth-stimulating effect