A Warning About PRP Injections

[farmgirl]

I am watching this thread LesYou. Please update us on your experience. It would be nice if Pythonidler would let us know what Dr Cremers had to say, I have asked twice. Personally I would trust the Dr's good judgement but of course you need to make her aware of your concerns.

[pythonidler]

If you want to find out whether PRP injections (which are NOT the same as PRP drops) are pro or anti-inflammatory, then look at the body of evidence. Don't just cherry-pick articles that support your argument. What do most papers and websites say about PRP injections and inflammation?

For example, If you google "PRP injections anti-inflammatory," here are the first seven results that you get:

1. https://aoshogdocs.com/specialties/p...a-information/ - "the patient should avoid all anti-inflammatory medications for 7 days prior to procedure"
2. https://www.hss.edu/conditions_plate...plasma-prp.asp - "Because PRP is given in the hopes of optimizing the initial inflammatory response of healing,anti-inflammatory medications should likely be stopped at the time of PRP treatment"
3. https://www.spinemd.com/news-philant...e-have-answers - "It is critical to avoid anti-inflammatory medications"
4. https://www.sports-health.com/treatm...tion-procedure - "Stop taking non-steroidal anti-inflammatory drugs" "The platelet-rich plasma typically stimulates a series of biological responses, including inflammation" "Platelet rich plasma injections may cause temporary inflammation, pain, and swelling"
5. https://www.arthritis-health.com/tre...tion-procedure - "Stop taking non-steroidal anti-inflammatory drugs"
6. https://www.ncbi.nlm.nih.gov/pubmed/26665098 - "Autologous PRP produced from subjects after NSAID [non-steroidal anti-inflammatory] medication shows significantly impaired platelet function"
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3565396/ - "Platelets adhere to exposed collagen and circulating extracellular matrix proteins, which triggers the release of bioactive factors from alpha granules⁽²⁰⁾. These bioactive actors include growth factors, chemokines, and cytokines, in addition to pro-inflammatory mediators"

All seven pages seem to indicate that PRP injections are pro-inflammatory. Why are PRP drops different? I'm not 100% sure, because I'm not a doctor, but I believe it has to do with platelet activation. In the original lacrimal gland study (Avila 2014), the paper says in regards to the PRP, "The inferior 1 mL was isolated, and 0.1 cm³ of CaCl was added to activate platelets." I'm sure this is something that is NOT done with drops made from either serum or PRP.

Regarding the results from PRP injection into the meibomian glands, the risk of having increased ocular surface inflammation is probably less than if the PRP is injected into the lacrimal glands. However, considering how much inflammation is present in the meibomian glands of people with MGD, it seems like an unnecessary risk to add extra inflammation to the glands. You may have new meibomian gland cells in the short-term, but in the long-term you may have significantly increased the amount of inflammation in your glands - which may lead to quicker gland atrophy.

Consider this before you get a PRP injection.

[pythonidler]

For the record, I'd like to say that I don't think Dr. Cremers is a bad doctor.

On the contrary, I think she's a very kind and compassionate doctor who is certainly more knowledgeable about dry eye than your average ophthalmologist. If I thought she was a bad doctor, I wouldn't have gone back two weeks after the lacrimal injections to get probing done from her. And the relief I got from the manual expression she did lasted far longer than the expression I got from my local doctor who had done an IPL only a few weeks earlier.

That being said, I think the body of evidence says overwhelmingly that PRP injections are pro-inflammatory. After talking with my Boston doctor, I'm very confident it was the excess inflammation caused by the injections which led to my initial grittiness, and the need to use more serum tears to avoid the sensation.

Also, in the interest of fairness, I thought I would also share that when I told Dr. Cremers what happened, she said that I was the only patient thus far that had experienced a negative reaction from the injections. At least 5 other patients who had lacrimal injections improved - although it's not clear what other procedures (e.g. probing) they had done along with the injections. Consider this information, as well as the other information I've shared with you, when you decide whether to get these injections or not.

This will be my last post on this topic.

[Guest]

Last post here too. I agree we are not scientists, so just wanted to make the case that it's hard for us to know exactly what's causing what, especially as the eye is so complicated.

I've had several prp injections stabbed into my patella tendon which your articles refer to and immediately there was inflammation from the injection. The prp then helps to kick start a chain of events that eventually lead to healing.

This is shown by your reference 7:

The general healing cascade involves four overlapping phases: (1) hemostasis; (2) inflammation; (3) cellular and matrix proliferation, which begins within days of an injury and comprises the most important phase of healing; and (4) wound remodelling, the longest phase, which may involve scar tissue formation^{(17, 18)}.

Immediately following injury, capillary leak allows for the recruitment of hemostatic factors and inflammatory mediators. The coagulation cascade is activated leading to platelet aggregation, clot formation, and development of a provisional extracellular matrix construct⁽¹⁹⁾. Platelets adhere to exposed collagen and circulating extracellular matrix proteins, which triggers the release of bioactive factors from alpha granules⁽²⁰⁾. These bioactive actors include growth factors, chemokines, and cytokines, in addition to pro-inflammatory mediators such as serotonin, bradykinin, prostaglandins, prostacyclins, thromboxane, and histamine⁽²¹⁾.

Suggesting prp injections into the glands would help them grow then later would cause then to shrivel doesn't make sense to me, as once grown presumably inflammation would reduce due to better oil production.

Might be wrong though. All this is experimental and complicated, and my eyes are too bad to try and understand it properly!

[farmgirl]

I guess it's like anything else, you takes your chances. If 5 improved and one got worse, I am so desperate that I would play the odds and hope that I am the one that got better.

Pythonidler I sincerely hope that in time you will hit the healing phase and improve. That could be months later as it was for me when I had prolozone into my shoulder. I got worse before I got better but about 3 months after just the second injection (I was scheduled for 3) my shoulder is perfect again. I was told I was heading for a frozen shoulder and needed a cortozone shot. Because I am anti-cortozone (the quick fix) I decided to go the better route and stimulate actual healing....it worked!

[LesYou]

Hi Farmgirl,

I am trying to get up the nerve to ask Dr. Cremers prior to my appointment on March 27 about the cases she has treated with PRP and came out with corneal damage. I've been seeing her since 2016, and I must admit she has done more for my DED than any other ophthalmologist I've seen in my lifetime.

I will post on this site anything of value regarding my MG probing or PRP injections into my meibomian glands. //LesYou