Platelet-Rich Plasma Injection

[Pinky]

Restoration of Human Lacrimal Function Following Platelet-Rich Plasma Injection.

http://www.ncbi.nlm.nih.gov/pubmed/24240491

[spmcc]

Thanks, Pinky!

I find this very interesting... and I wonder why it hasn't been tried before. The only thing I've ever heard of injected into the lacrimal glands is steroids (to try to take down inflammation and get the glands producing again).

But I really wonder about the methods in this study... the participants had PRP injected adjacent to the lacrimal glands on Day 0, Week 4, Week 8 and Week 12. And they were followed until Week 12 (when they had the final injection). So I don't know if the researchers can say that the injections were effective in increasing lacrimal production. I'm wondering if it wasn't just PRP coming out of the glands and that would stop within a certain amount of time.

I guess as the authors write: additional studies are required! I'd definitely be a guinea pig for this...

[ebel]

"RESULTS::
All cases showed a significant improvement in lacrimal volume (from 3.3 ± 0.8 mm to 11.1 ± 2.3 mm). In all the patients, an increase in tear break-up time values and a decrease in ocular staining (basal 8.0 ± 0.61-2.8 ± 0.5) with subjective improvement occurred. None of the patients presented any adverse effect, and none reported pain or discomfort. Additionally, no complications were observed.
CONCLUSIONS::
Injected platelet-enriched plasma was found to be safe and effective in increasing lacrimal production and in improving ocular staining secondary to severe dry eye. This approach could be an alternative for the management of these patients, although additional studies are required to perfect the technique".


The idea seems simple, but the execution not so much. The results are impressive, but it is difficult to conclude anything without reading all the text.

[Jade]

2 years ago I tried platelet rich plasma tears for 2 months. The med center I went to made them just like serum tears from my blood but kept the platelets in. The only effect I got was a lot more mgd debris on the edge of my lower lids which went away after 2 months of oral minocycline 100mg 2x day which gave me the side effect of a low grade flu feeling but the excess debris went away.
I think any blood based substance in the eye could be food for bacteria.

[ebel]

The few posts about this study surprised me. Perhaps, it is the most interesting I've read (and I've read a lot about dry eye ). It is possible that I have been impressed with the results presented , creating an illusory hope. Bit I think more reviews should be undertaken. As in ' pubmed ' only the ‘Abstract ' is available, I made a summary of the article . I emphasize that this is a summary , subject to my interpretation (and I’m not a physician and english is not my maternal language).
I have some questions and doubts about the research. Their results are impressive . However , the sample is very small. Anyway , I believe it deserves attention , since I had never read about any similar treatment. That is, the use of PRP to treat the lacrimal gland itself. I had only read about its use in eye drops to treat ulcers and other severe disorders of the cornea.
Here is the summary:

"The author explains that the platelet-rich plasma (PRP) has emerged as a strategy to restore cells in different fields of medicine, involving, for example , bones, tendons, hair growth , skin rejuvenation , burns , among other applications.
The preparation of PRP promotes a concentration of biologically active proteins , including different growth factors known to induce cell migration and differentiation of various cells and tissues.
The writer highlights the key role played by epitheial-mensenchymal transition cells in the glandular regeneration process :
" Epithelial-mesenchymal transition cells are responsible for tissue repair, remodeling, and regenration in several tissues, including mamary glands, liver, and lacrimal gland. In these cells, platelet-derived growth factor induces proliferation. Activation of these cells could induce the regenaration and proliferation of epithelial-mesenchumal transition cells to glandular and ductal cells, thus regenerating the lacrimal gland. This would be useful in cases where palliative therapy is the only resource available"
The lacrimal dysfunction is a hallmark of the Sjogren's Syndrome and results in severe dry eye . The lacrimal gland is affected by chronic inflammation of the acinar cells and the regeneration of these cells is affected.
So , the Colombian doctor treated 4 patients with this disease through injections of autologous PRP in the area of the lacrimal gland, evaluating the effects observed in tear production .
Patients accepted the procedure in accordance with the Declaration of Helsinki and the protocol was approved by the Ethics Committee of the School of Medicine ( Universidad Nacional de Colombia ) .
Approximately 1 mL of PRP was injected " in the external ( ... ) 4 , 8 and 12 weeks ."

Results (Average )

Lacrimal volume - Schirmer I test ( without anesthesia )
Pretreatment values: 3.3 + - 0.8 mm
4 weeks: 7.0 + - 1.1 mm
8 weeks: 8.5 + - 1.4 mm
12 weeks: 11.1 + - 2.3mm

Tear Break-up Time ( TBUT )
Pretreatment values: 4.3 + - 0.4 s
4 weeks: 9.6 + - 1.7 s
8 weeks: 10.8 + - 1.3 s
12 weeks: 12.3 + - 0.7 s

Conclusions
According to the author, the study demonstrates a reactivation of lacrimal function, with an increase in tear production and a decrease in the inflammatory process .
Meibomian glands were not directly activated by the PRP. However , the researcher points out that "( ... ) paracrine action in a better local environment might increase the function of lipid glandular cells and induce a regenerative process in this subgroup of glands, which is likely caused by an increase in the lacrimal volume".
Despite the very small sample, he concluded that the study indicated a restoration of lacrimal gland with increased volume and reduction of tear associated with dry eye syndrome. The procedure proved to be safe, although further research is needed to establish the effectiveness of the use of PRP for glandular regenaration".

[ebel]

A fragment of the summary was missing:
“Approximately 1 mL of PRP was injected " in the external one-third of the orbital rim and 4 mm in depth to the superior area. The reference was the area of the lacrimal fossa in the frontal bone. This anatomic area corresponds to the localization of the lacrimal gland. This procedure was completed on day 0 and at 4 , 8 and 12 weeks”.

[steveyez]

Ebel - Thanks for the update - ive been using PRP eye drops 3 times a day for several months now and very gradually i have felt more comfortable as time has gone by

Medically i report increased TBUT and Schirmer scores but it does not subjectivally feel as though i am producing basal tears - i am planning to continue with the PRP eye drops but this new development that you report looks very promising albeit with a very small sample size

Does anyone know if the PRP that is injected is just the same as the PRP eye drops ? and has this treatment been trialled or is available in Europe?

Steve

[NotADryEye]

ebel, can you post the link to abstract or the title of the article? Thanks.

[ebel]

NotADryEye, the title of the article was mentioned in the initial message of this topic: “Restoration of Human Lacrimal Function Following Platelet-Rich Plasma Injection”. I think it would be better if this topic had the title "Restoration of human lacrimal function".

The link to the abstract was also showed. Here it is: http://www.ncbi.nlm.nih.gov/pubmed/24240491

Steveyez, I can’t assure you that the PRP used in the study has the exact composition of your PRP eyedrops. However , if there are differences, I believe that the technology used to produce your eyedrops is sufficient to produce the PRP that was injected. Here is the specific description of the PRP , in the paper: "Ten milliliters of whole blood was collected by venopuncture in sterile tubes containing sodium citrate 0.5 mL (Beckton Dickenson). The blood was centrifuged at 160g for 10 minutes . The plasma was isolated (~ 5 ml per patient ) and was centrifuged again at 160g for 15 minutes . The inferior 1 ml was isolated , and 0.1 cm3 of CaCl was added to activate platelets. "

The procedure is not very complicated . Your PRP eyedrops help in the recovery of your cornea , such as the autologous serum eyedrops I use. What surprises me is the use of PRP to act directly on the lacrimal gland. To me, it's a novelty . I think that only Restasis would have this goal, but with limited effectiveness .

The doctor who wrote the article is Colombian (Professor of the Universidad Nacional de Colombia), although , like many others, had part of his training in the United States. I do not know if he has been offering this treatment. The research seems at an early stage. We need to know better what types of patients would benefit from the treatment, as well as what the real risks and possible side effects. But, if this technology is available in many places, others doctors and researchers could also investigate and it would not be necessary to wait for the pharmaceutical industry and the complex approval procedures for palliative drugs.

[NotADryEye]

Must have missed the earlier post. Thanks!

[steveyez]

Thanks for the further update Ebel - this definitely looks a promising approach

[ebel]

It seems that the doctor is performing another trial. I hope he gets such impressive results as presented in the first study. Surprises me that no one else has tried this pathway.
I expect we have news later this year.
Here is the link:
https://clinicaltrials.gov/ct2/show/NCT02257957

[Gerri55455]

Steveyez, how have you been? Now, could you advise me on how to best conserve serum eyedrops for flight. I will be flying to Chicago to get mine drawn and I have about 5 hours from the time I leave the hospital, take the train to the airport, check-in, fly back, catch the shuttle to my car and drive home. I bought an Icy Diamond Tote but I might need something more sophisticated! Thanks! Gerri

[steveyez]

Steveyez, how have you been? Now, could you advise me on how to best conserve serum eyedrops for flight. I will be flying to Chicago to get mine drawn and I have about 5 hours from the time I leave the hospital, take the train to the airport, check-in, fly back, catch the shuttle to my car and drive home. I bought an Icy Diamond Tote but I might need something more sophisticated! Thanks! Gerri

Gerri it should be really easy - in Alicante they supply the PRP in 12 bottles in a sealed pack with an ice block - that should be fine for 12 hours - the key is not to put the PRP drops in the freezer before you get home - just make sure they're kept cold - 4C is fine

[hosanna13]

Anyone considered doing the injections themselves? PRP is just what serum tears are made of, no?