Autologous fibrin membrane combined with solid platelet-rich plasma in the management of perforated corneal ulcers: a pilot study.

Abstract

IMPORTANCE:

The combined use of autologous fibrin membrane and the eye platelet-rich plasma (E-PRP) clot could be considered as a new surgical alternative for the closure of corneal perforations.

OBJECTIVE:

To evaluate the use of autologous solid platelet-rich plasma in combination with an autologous fibrin membrane as a surgical alternative for wound closure in perforated corneal ulcers.

DESIGN:

Both the fibrin membrane and the E-PRP clot were prepared with the patient's own blood just before the operation. Nylon stitches were used to fixate the fibrin membrane to the conjunctiva and then 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. We conducted postoperative monitoring for 3 months. SETTING Vissum Corporacion Oftalmologica, Alicante, Spain.

PARTICIPANTS:

Eleven patients with perforated corneal ulcers.

INTERVENTION:

Surgical alternative for the closure of corneal perforation.

MAIN OUTCOMES AND MEASURES:

Corneal biomicroscopy, fluorescein test, digital tonometry.

RESULTS:

In all cases the corneal perforation was sealed. The fibrin membrane was present over the corneal surface for the first 3 to 5 days and then gradually disappeared. 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 3 months' follow-up, there was no evidence of relapses or perforations. Corneal grafting was eventually performed in 7 of the 11 cases.

CONCLUSIONS AND RELEVANCE:

The combined use of autologous fibrin membrane and E-PRP clot is a safe and effective surgical alternative for the closure of corneal perforations. This technique can be considered as a temporary measure until the condition of the cornea permits definite intervention.

• Authors: Jorge L Alio, Alejandra E Rodriguez, Lorena M Martinez, Alvaro Luque Rio
• Journal: JAMA ophthalmology (JAMA Ophthalmol) Vol. 131 Issue 6 Pg. 745-51 (Jun 2013) ISSN: 2168-6173 [Electronic] United States
• PMID: 23559361 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Biocompatible Materials
• Fluorescent Dyes
• Membranes, Artificial
• Fibrin
• Fluorescein

Topics

• Aged
• Aged, 80 and over
• Biocompatible Materials
• Corneal Perforation (diagnosis, pathology, surgery)
• Corneal Transplantation
• Corneal Ulcer (diagnosis, pathology, surgery)
• Female
• Fibrin (adverse effects, therapeutic use)
• Fluorescein
• Fluorescent Dyes
• Humans
• Male
• Membranes, Artificial
• Microscopy, Acoustic
• Middle Aged
• Pilot Projects
• Platelet-Rich Plasma
• Predictive Value of Tests
• Reoperation
• Spain
• Suture Techniques
• Time Factors
• Tonometry, Ocular
• Treatment Outcome
• Wound Healing (drug effects)
• Young Adult