EYE- PLATELET RICH PLASMA THERAPY (E-PRP) FOR CORNEAL

INJURIES/ULCERS
Dr. Melvin V. Jacob M.V.Sc. (Veterinary Surgery & Radiology)

Blood derived bioactive therapeutics has demonstrated their ability to accelerate the rate of
healing and unleash the regeneration potential of different tissues and this enhancing effect is
due to the presence of growth factors and bioactive proteins in the blood. Eye platelet rich
plasma (E-PRP) provides higher concentration of essential growth factors and cell adhesion
molecules by concentrating platelets in a small volume of plasma as compared with autologous
serum, the latter being used widely in ophthalmology for epithelial wound healing of the cornea
for the last two decades. These growth factors and cell adhesion molecules have a major role
in wound healing and enhance the physiological process at the site of the injury/surgery via
eye drops or clot. E-PRP has been used more recently, and has achieved successful outcomes
in peer-review articles in the treatment of dormant ulcers (epithelial defects of the cornea that
fail to heal), moderate to severe dry eye syndrome, and for surface reconstruction after corneal
perforation.
E- PRP is significantly different from plasma rich in growth factors (PRGF) which has
higher concentration of growth factors but require designated laboratory equipment’s for
preparation. E-PRP drops can be prepared easily without much expense but strictly under
sterile conditions. E-PRP preparation requires one-step centrifugation (1000 rpm for 10 min)
using sodium citrate (3.8%) as an anticoagulant and careful collection of platelet rich plasma
from the plasma layer just above the buffy coat using a pipette. 10 ml whole blood may yield
1-1.5 ml of PRP. E-PRP is used as topical eye drops for surface application and as a clot (solid
E-PRP) for surgical procedures in ocular reconstruction. PRGF preparation requires specially
designed devices and is based on a double centrifugation technique, whereas E-PRP
preparation uses commercial tubes to obtain the blood and typical laboratory centrifuge to
separate plasma. Moreover, PRGF needs sodium calcium chloride as a clot activator, calcium
chloride is only used for the activation of liquid E-PRP when clots are needed for surgical
procedures, such as corneal perforation treatment. Eye drops of E-PRP contain 100%
autologous plasma and the maximum number of platelets in suspension after a single
centrifugation, without any other additive. Platelets deliver plenty of growth factors, cell
adhesion molecules, and cytokines from alpha granules. The growth factors released prompts
a cascade of many reactions responsible for migration, mitosis, extracellular matrix formation,
and angiogenesis promoting proliferation and differentiation of corneal cells. The major effects
of PRP are derived from platelet-derived growth factor, which is the first growth factor to
appear in the wound to increase the number of repaired cells, stimulate angiogenesis, and
support the development of new blood vessels and the activated macrophages enhances the rate
of healing.
E-PRP therapy is a promising new paradigm in regenerative medicine. The main
advantage of E-PRP is that it can be easily prepared under field conditions even without an
elaborate laboratory setup, enabling the practising vets to provide a better treatment to corneal
insults.