A Warning About PRP Injections

[pythonidler]

There have been multiple posts regarding procedures to inject platelet-rich plasma (PRP) into either the lacrimal glands or meibomian glands to either increase tear production or oil production.
http://www.dryeyezone.com/talk/forum...asma-injection
http://www.dryeyezone.com/talk/forum...asma-injection
http://www.dryeyezone.com/talk/forum...rred-ones-also

About a month ago, I went to Dr. Cremers and had injections into the lacrimal glands. A few minutes after the injections, my eyes started to feel gritty for the first time in over a couple years. The grittiness is from deteriorated nerve sending false signals to the brain, a condition known as corneal neuropathy.

Ever since December 2015 when I was put on serum tears 8x/day, I had not had grittiness in my eyes. After the procedure, my eyes were gritty for the entire day despite me putting in serum tears very frequently (probably every 20 minutes or so). I woke up the following morning with no grittiness, but have found I need to put serum tears in about 30-35x a day to stave off the grittiness.

Yesterday, I took a a visit to my doctor in Boston, who has a confocal microscope (used to image the corneal nerves). He found that since my last visit in November 2017, I have about 20-30% fewer nerves and have formed a few abnormal nerves, despite the fact that I'm taking serum tears 2-3x as much.. This is VERY BAD.

I believe the reason this happened is because PRP contains many pro-inflammatory components. Normally, PRP is used on damaged muscle tissue, and the increase in inflammation leads to healing of the tissue. With dry eye, adding more inflammation is a really, really bad thing to do.

I would warn everyone against getting this procedure. It may work for people with a "normal" level of inflammation, but chances are if you're on this board then you have a very high level of inflammation already in your eye. You don't want to make that worse.

[DKott27]

I was considering this procedure. I still may consider because I'm so desperate and honestly I don't think it could get any worse than it is. Serum tears help you though? That and IPL are the only two things I haven't tried. How many glands do you have left in your eyes?

[bobXfr]

Why putting the PRP in the 2 lacrimal glands the same time? it's very dangerous.
maybe prp injection in lacrimal gland as it is today, is not good for every one.
Dr Cremers had at least one good result by PRP in the meibomian glands as mentioned in her blog.

i hope your glands will be better

[farmgirl]

I am sorry to hear this as I was hopeful for the future of this treatment. Perhaps it can be refined, it is fairly new and probably somewhat experimental. What did Dr Cremers have to say about your results? Do you have Sjogrens?

IN this study.... https://www.ncbi.nlm.nih.gov/pubmed/24240491 ....there were a series of 4 injections done a month apart adjacent to, not into, the gland, and in all 4 cases the results were encouraging. None of the patients reported any adverse effects. It is something that I still won't rule out.

[bobXfr]

The stem cell therapy is the cure for all degenerative illness no doubt, i'm sure about it and it's logical. The question is when it will be.

[farmgirl]

About a month ago, I went to Dr. Cremers and had injections into the lacrimal glands. A few minutes after the injections, my eyes started to feel gritty for the first time in over a couple years. The grittiness is from deteriorated nerve sending false signals to the brain, a condition known as corneal neuropathy.
.

I am finding it hard to believe that the lacrimal gland injection could cause corneal neuropathy. I googled corneal neuropathy and came up with this.

"Ocular neuropathic pain, also referred to as corneal neuropathic pain, is a condition where corneal pain is seen in response to normally non-painful stimuli. This results from repeated direct damage to corneal nerves."

It appears, as stated, that the damage in corneal neuropathy is from repeated direct damage to corneal nerves. That was not what happened to you. The grittiness started within minutes of the injection which was no where near the cornea. It is possible that if your dry eye worsened that the corneal nerves could be affected but yours didn't take days or weeks to start, it started immediately, within minutes. I would therefore conclude that the lacrimal gland was somehow negatively affected....I want to know what Dr Cremers had to say about it....please share.

[pythonidler]

This will be my last post in a while on this forum. I can't tolerate using the computer nowadays and have to spend 95% of my day with my eyes closed. My eyes are closed now as I am typing this.

1. The initial PRP study, done in 2014, was done on Sjogren's Syndrome patients only. Sjogren's Syndrome dry eye is different from Lasik or computer induced dry eye. With Sjogren's, the inflammatory cells are directly attacking the lacrimal glands. Any therapy that regenerates those lacrimal gland cells would be effective. With non-Sjogren's, the problem is the nerves. As my doctor explained to me on Friday, my inflammation is centered around my corneal nerves. The nerves are important because they signal to the brain to produce tears. With corneal neuropathy, those nerves degenerate and the brain isn't getting adequate information about the surface of the tear film - thus, fewer tears are produced. With non-Sjogren's dry eye, the challenge is restoring nerve function.

2. Even though the injection was made adjacent to the lacrimal gland, it will eventually drain down to the eye. Because if tears can get from the lacrimal gland to the eye, then so can an injection that is targeted to it.

3. Serum tears and IPL have been the most effective treatments for me to date. Serum tears are eye drops made from your blood serum, which contain several nerve growth factors. By restoring the nerves, you increase tear production. IPL targets your meibomian glands. If you have thick oil in your glands, IPL may help you tremendously (assuming your glands aren't blocked by scar tissue).

So why did I get a grittiness in my eyes after the injections? Because the PRP drained through the lacrimal gland ducts onto the surface of my eye. The pro-inflammatory parts of it immediately increased the inflammation in my cornea, and as a result my nerves quickly deteriorated. If you have non-Sjogren's dry eye as I do, it would be foolish to do this procedure.

[konadog15]

I have found both autologous serum tears and IPL helpful.

[Guest]

I really don't understand this. I have PRP drops for my eyes, which are very similar to autologous serum. I can't see how PRP would be damaging whereas autologous serum is not?

[Guest]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693817/
(Article an benefits of PRP drops for the cornea)

Two hundred and ninety-seven (80.7%) patients were women, and 71 (19.3%) were men. Two hundred and thirty-two (63%) patients had EDED, while 136 (37%) had ADDED. After 6 weeks of monotherapy treatment with autologous PRP, dry eye symptoms improved in 322 (87.5%) cases. A decrease of corneal fluorescein staining was observed in 280 (76.1%) patients.

[Guest]

The article also says this: Platelet rich plasma (PRP) and plasma rich in growth factors (PRGF) have also been reported as successful treatments for moderate to severe dry eye, presenting advantages over AS due to its richer concentration of growth factors, anti-inflammatory cytokines, and other platelet derivatives, which could be beneficial for the required ocular surface restoration in moderate to severe forms of dry eye.

*I'm not trying to contradict your advice, but think dry eye is so complicated that its hard to understand what/why things are happening.

[Guest]

Also one last science paper: https://www.ncbi.nlm.nih.gov/pubmed/23446019
I think it explains how PRP drops had no effect after LASIK in helping corneal nerves regenerate but the PRP had beneficial effects on healing. I cant see how one PRP injection could therefore cause a 20% drop in nerves.
P.S. I have severe dry eye from the computer plus reduced sensitivity and am desperate for a cure, so just posting these articles to try and help increase understanding.

[farmgirl]

Even though the injection was made adjacent to the lacrimal gland, it will eventually drain down to the eye. Because if tears can get from the lacrimal gland to the eye, then so can an injection that is targeted to it.

I agree Lena, I fail to understand how, if the injection was made adjacent to the lacrimal gland, how the PRP could get into the glandular tissue, then into the tears, drain down to the cornea and damage nerves within minutes. I think there is something else going on there.

[farmgirl]

I am sorry Pythonidler that you are so severe, it is a tragedy that you need to keep your eyes closed 95% of the time. I hope things improve for you. I am assuming you are then a post lasik victim. I remember that you tried IPL and MG probing which helped. Do you think another IPl treatment would be helpful? I am still curious to know what Dr Cremers had to say about the grittiness you are experiencing after the shot into the gland.

[LesYou]

I agree with farmgirl. Did Dr. Cremers admit the PRP injections caused your corneal neuropathy? I am scheduled to have MG probing and PRP injections into my meibomian glands on March 27th with her, and your posts have me frightened to death. Please tell us what she said. I can't believe she would proceed with injections if they made people worse off than they started. She is an outstanding doctor and has helped me more than any other ophthalmologist in the last 15 years I've had this disease. I trust her, but I would still like to know her thoughts about your case.