Lacrimal Gland PRP injection & PRP drops - Prof. Alio, Vissum, Alicante

[Meibum Ian]

Background

Sudden onset of dry eye 1 year ago. It started after an IPL treatment for facial rosacea, and become worse after a second treatment 1 month later. I do not claim that IPL caused my problem but it has always remained a possibility in my mind.

With my various consultations there has been general agreement that there is significant inflammation and telangiectasia of eyelids with an assumed connection to facial rosacea (which itself isn’t that bad these days). MGD was diagnosed early, with aqueous deficiency being confirmed later.

On 40mg Doxycycline since Jan 2018, Ikervis (0.1% cyclosporine) since Jun 2018.

Lower plugs since Jul 2018

Schirmer I (without anaesthetic) 0mm/1mm in Jun 2018. 5mm/10mm in Aug 2018.

Osmolarity 300 / 315 (at times there has not been enough tear to take a reading)

TBUT generally ~ 3 seconds

Have been told various things re. corneal staining. Everything from grade I - IV.

Meibography good, with no dropout. Decent lipid layer, but some obviously blocked and tender glands.

Started Fingerprick Autologous Blood drops in Jul 2018 with seemed to kickstart some improvement.


Visit to Vissum, Alicante

Last week I visited Professor Jorge Alio at the Vissum Clinic in Alicante, Spain. I went with the intention of getting PRP drops made and of course knowing that I would have yet another consultation with the possibility of learning something new.

I found Vissum a very impressive and inspiring place to be. I was treated with kindness and warmth by the reception staff, nurses and optometrists.

Prof Alio founded the clinic and has a very impressive CV. My impression that he is genuinely driven by wanting to help people. He also spoke to me with warmth and probably the most respect of any consultant I’ve seen. He spoke at quite a technical level I assume based on the nature of my comments and questions.

Tests done included slit lamp exam (grade I / II staining), and keratography including meibography. He did a Schirmer II test (with anaesthetic) which was 0mm in both eyes. I always feel horribly despondent when I get results like this. He said it was exceptional for someone my age to have this poor a result.

He felt my ability to produce reflex tears indicated OK nerve function, but that the total lack of basal tears was obviously a serious problem and indicated issues with the main lacrimal gland. Based on this he agreed that PRP drops were necessary, and also offered the option of PRP injections into (or possibly adjacent to?) the main lacrimal gland and also the lower conjunctiva in order to assist the accessory glands.

I was vaguely aware of this procedure but had no idea that it was done at Vissum. They had done it on around 30 patients with no complications and about 70% having significant improvement. The other 30% generally had worse signs than me to start with. With my flight home in 2 days he offered to do the procedure (assuring me that he personally would perform it) next day. He said I could decide on the day day whether to go ahead, so I drew up a list of questions that evening, along with descriptions of some of my symptoms that I hadn’t had time to go into, in case they altered his opinion on my condition.

Next day, having been satisfied with his answers, and not wanting to spend weeks / months deliberating over what to do and knowing I’d still be no closer to knowing the outcome of the procedure I decided to go ahead. I am not one to put blind trust in doctors, but I did feel I could trust Prof Alio in this. There would be a follow up the morning after (the day of my flight).

The procedure was done in the operating theatre under pill sedation. I could have been injected with a sedative but we both decided I shouldn’t need it. It was not too uncomfortable and, for me at least, preferable to having a dental filling.

Following the procedure, my eyes were pretty tender, red with expanded conjunctiva , and very puffy underneath. Frankly I looked like shit. I was pretty concerned by this but told it was normal when I went to ask and that it would be settled by morning. It wasn’t. Things never seem to go simply for me and I assumed this was another example of that. With my flight back in the afternoon and stuck in a foreign country on my own and the accommodation I was in unavailable next day I was panicking a bit.

At the follow-up appointment, Alio assured me this was all OK and that he wasn’t concerned. I do wish I could have been better prepared for this. At the slit lamp he said my eyes looked better already, with more moisture. Schirmer II was 5mm/6mm. I had been crying in the morning so this may have affected things. He jokingly told me off for welling up as we said goodbye as the reflex tears wouldn’t help my condition!

I was ok on the flight home, tender but a bit more moist than usual. A few days later now and I’m looking close to normal, and eyes are probably a bit more moist than before. I am trying not to think or obsess about it too much. Also am on steroid drops for a few days. Alio asked me to email my experiences in a couple of weeks.

The PRP drops feel great in the eye. They are 100% serum, with no saline added (I think they diluted it in the past?). Alio explained that they should be much better than fingerprick drops, the red and white blood cells of which are not very helpful to the eye and somewhat pro-inflammatory, despite the blood probably being beneficial overall. The PRP feelsl lubricating and will replace all artificial tears for now. I have 11 weeks’ worth, and Alio thought I might not need it beyond that. This seems hard to believe but we’ll see.

Apologies for the length! I will update this thread with my findings and am happy to answer any questions.

Updates

I will post updates in the thread and link to them here.

Day 6 update: http://forum.dryeyezone.com/forum/dr...416#post216416

Day 14 update: http://forum.dryeyezone.com/forum/dr...020#post217020

Day 50 update:
http://forum.dryeyezone.com/forum/dr...996#post21899

Day 58 update (follow-up appointment):

http://forum.dryeyezone.com/forum/dr...248#post219248

[MGD1701]

Thanks for sharing and taking questions.

You wrote: ''The PRP drops feel great in the eye. They are 100% serum, with no saline added (I think they diluted it in the past?). Alio explained that they should be much better than fingerprick drops, the red and white blood cells of which are not very helpful to the eye and somewhat pro-inflammatory, despite the blood probably being beneficial overall.''

If PRP drop is 100% serum why it differs from your fingerprick's?
Such PRP drop is mainly for water issue not for MGD, right?

Did prof. Alio estimate how long you can expect a solid result?
How does he monitor/evaluate the progress? Did he check your inflammation level, like MMP-9, prior to PRP?

Hope you achieve what you expected, of course. Thank you again.

[Meibum Ian]

Thanks for sharing and taking questions.

You wrote: ''The PRP drops feel great in the eye. They are 100% serum, with no saline added (I think they diluted it in the past?). Alio explained that they should be much better than fingerprick drops, the red and white blood cells of which are not very helpful to the eye and somewhat pro-inflammatory, despite the blood probably being beneficial overall.''

if PRP drop is 100% serum why it differs from your fingerprick's?

By my understanding, the extracted blood is spun in a centrifuge, removing white and red blood cells and "other stuff". further processing is done to throw away less helpful components and get more platelets. Happy to be corrected on any of that. More info on the process at https://www.ncbi.nlm.nih.gov/pmc/art...891/#sec2title

"Generally, 24 to 40 mL of platelet-rich plasma was obtained from 100 mL of the total blood. " Suggests that 60-76% of whole blood is not helpful..

Inflammation seems to be an issue, what was your level, any objective testings, like MMP-9, prior to PRP?

Nothing objective, no. Consensus across all doctors (with some varying subjectivity). I think mainly based on eyelid redness / erythema and telangiectasia

Did prof. Alio estimate how long you can expect a solid result? How does he monitor/evaluate the progress?

At least 6 months if it works. Hopefully longer. Slit lamp / staining / Schirmer I suspect will be main methods but not sure. Going back in two months for a followup.

[hannahmaywils]

Wow Meibum Ian Thank you so much for posting this. Please keep us updated with your results- Did Alio explain what exactly the PRP injection does ? You've said above " 6 months if it works"? What do you mean by this ?

Thanks

[MGD1701]

Thank you. If this works, do you need to do it on a regular basis?
Now I remember Dr Toyos also does PRP drop, apart from IPL. Good luck!

[Meibum Ian]

Wow Meibum Ian Thank you so much for posting this. Please keep us updated with your results- Did Alio explain what exactly the PRP injection does ? You've said above " 6 months if it works"? What do you mean by this ?

Thanks

I will indeed update. Like many of us here, I've put hope in a few treatments and been disappointed so really just trying to wait and see..

In theory repair a damaged lacrimal gland (and accessory glands in lower conjunctiva). The result should be increased aqueous tear production. The effect should last at least 6 months. May need doing again, if it works but the effect fades. That would be expensive but I think worth it.

More info here: http://eyedoc2020.blogspot.com/2017/...mal-gland.html

[Meibum Ian]

Thank you. If this works, do you need to do it on a regular basis?

I think this probably depends on whether the conditions that led to the gland becoming compromised in the first place are now absent.. Hopefully with inflammation being controlled (doxy, PRP, Ikervis) that might be the case.

[farmgirl]

I have Sjogrens so am really interested in your results, I will be watching

[Meibum Ian]

I have Sjogrens so am really interested in your results, I will be watching

Thanks. Don't be too discouraged if it doesn't work for me - my case is probably weird. When the procedure has been tried on sjogrens patients results have been pretty good.

Are you on any systemic medicine? They also took my blood to test for autoimmune and the professor mentioned such medicine this would be helpful if results came back positive. I have had tests before but only ANA and RF, and vissum will do more (though not sure exactly what).

[Guest]

Thanks for posting...the prp injections into the lacrimal and meibomium glands seems so promising. I hope you get some relief from this.

Prp is really great for healing wounds. So I’m assuming that staining is going to clear up fast. By my understanding, I think the prp is limited to what he gave you because it can cause overgrowth and neovascularization in the cornea. So I’m assuming, once your surface is healed and filled in, you won’t need it anymore. I would push for serum if you like the drops though. They don’t carry the same risks as the prp drops...yet still give you the comfort and nourishment. I’m speculating as to why though, I have no clue, I’ am however very curious to see how this story unfolds.

[Meibum Ian]

Prp is really great for healing wounds. So I’m assuming that staining is going to clear up fast. By my understanding, I think the prp is limited to what he gave you because it can cause overgrowth and neovascularization in the cornea.

Thanks. I'd not heard of risks from overuse of PRP before. Anything you can link to on that?

[Guest]

Thanks. I'd not heard of risks from overuse of PRP before. Anything you can link to on that?

I can look for you...when I was st UIC for my check up, I asked Pradeep Jain the difference between the 50% serum and the PRP. He said that it has much higher concentration of growth factors...and that using it could possibly cause neovascularization in the cornea. Since you don’t have any corneal defects to heal, the serum is a better choice.

This is just what I was told, but I’ll look for some evidence.

[farmgirl]

Hi Ian, no I am not on any systemic drugs. The Dr prescribed a very low dose of steroids but I was only 60 at the time and know that steroids are accumulative. The last thing I wanted to do was to exchange one problem for another like joint failure from steroid use over such a long period so I politely declined and have never regretted it. My blood work is not positive for Sjogrens as is very common which means that mine for sure is primary. If it was secondary I may have considered the steroids but I have no other mitigating factors, mostly just dry eye and mouth.

[Meibum Ian]

Day 6 update:

Swelling fully subsided 2-3 days ago. I was getting diffuse redness in my left eye on and off too, but this also seems to have settled now. Was on steroid drops until day 4 and these have stopped now.

As to whether it's working yet - I do feel there is an increase in moisture. I'm comfortable most of the time inside, sometimes even forgetting that I have dry eye. being outside without moisture glasses on is not really comfortable yet, but probably improved. I am trying not to get too optimistic / carried away at this point. Also don't want to be too obsessive / neurotic and tracking every up and down.

My main problem at the moment is a long standing one.. Both upper lids have some very blocked and tender glands. At times the blink becomes incredibly painful, as though there are razor blades embedded in them. In the past, when I was able to express them, my eye would react extremely badly to the released oils, turning red and stinging unbearably. In the last few months this has settled, but the released oils still feel very unpleasant. When the glands have on occasion opened, I've always felt hugely better. They're inevitably blocked, and not easily opened, by morning though.

These glands are expressing more easily than ever since the treatment but I can only partially express them, resulting in that painful blink and foreign body sensation.

Related to what comes out of these blocked glands is the occasional build up of white blobs and strands in my eyes. I'd previously suspected filamentary keratitis and asked several UK docs whether I have it to be told not. Prof Alio however said I do (without my asking). As I understand it, the strands are a mix of hardened meibum and epithileal epithelial cells, and the reason my blink feels so painful. He thought this condition would also improve from the PRP treatment.

[chuto]

Meibum Ian thank you for sharing your experience. As I have really bad red eyes, I would like to ask whether your eyes turned to normal from red after the PRP injection procedure?