Fishman comments: Dr. Fishman offers Plasma rich in growth factors (PRGF) autologous serum eye drops in his practice. PRGF is a form of autologous serum tear eye drop that can be used to treat severe dry eye and other ocular surface diseases. During the preparation of PRGF, a fibrin membrane is usually discarded but can be saved and used on the eye for sustained release. A neat paper highlighted here shows how mPRGF membranes can be a safe alternative to amniotic membranes and provide for more than a week growth factors including platelet-derived growth factor-AB, vascular endothelial growth factor, hepatocyte growth factor, and insulin-like growth factor-1.
Plasma rich in growth factors fibrin membrane (mPRGF)
Ronald M. Sanchez-Avila, MD, MSc,a,∗ Jesús Merayo-Lloves, MD, PhD,a Ana C. Riestra, MSc, PhD,a Silvia Berisa, MSc,a Carlos Lisa, MD, PhD,a José Alfonso Sánchez, MD, PhD,a Francisco Muruzabal, PhD,b,c Gorka Orive, PhD,b,c,d,e and Eduardo Anitua, MS, PhDb,c nitua, MS, PhD
“The mPRGF is able to retain for more than a week almost 30% of the growth factors content involved in tissue regeneration including platelet-derived growth factor-AB, vascular endothelial growth factor, hepatocyte growth factor, and insulin-like growth factor-1, among others. Leukocytes are not collected during mPRGF preparation thus reducing the content in pro-inflammatory proteins (IL-1b, IL-16, among others), characteristic that differentiates the mPRGF from other platelet-rich plasmas (PRPs) membranes.”
To evaluate the safety and efficacy of the surgical use of plasma rich in growth factors fibrin membrane (mPRGF) in different ocular surface pathologies.
Fifteen patients with different corneal and conjunctival diseases were included in the study. Patients were grouped according to the use of mPRGF as graft (corneal and/or conjunctival) or dressing; they were also grouped according to the surgical subgroup of intervention (persistent corneal ulcer [PCU], keratoplasty, superficial keratectomy, corneal perforation, and pterygium). Best corrected visual acuity, intraocular pressure (IOP), inflammation control time (ICT), mPRGF AT (PRGF membrane absorption time), and the healing time of the epithelial defect (HTED) were evaluated throughout the clinical follow-up time. Safety assessment was also performed reporting all adverse events.
mPRGF showed a total closure of the defect in 13 of 15 patients (86.7%) and a partial closure in 2 patients (13.3%). The mean follow-up time was 11.1 ± 4.2 (4.8–22.8) months, the mean ICT was 2.5 ± 1.1 (1.0–4.0) months, the mean mPRGF AT was 12.4 ± 2.0 (10.0–16.0) days, and for the global HTED the mean was 2.9 ± 1.2 (1–4.8) months. Results showed an improvement in BCVA in all patients, with an overall improvement of 2.9 in Vision Lines. The BCVA significantly improved (P < .05) in the groups of corneal graft and dressing. In the PCU subgroup (6 patients), the healing time of epithelial defect was significantly reduced (P < .05) in patients treated only with the mPRGF in comparison to those which mPRGF therapy was associated to the amniotic membrane. The IOP remained stable (P > .05) throughout the clinical follow-up time. No adverse events were reported after mPRGF use.
The mPRGF is effective and safe as coadjuvant treatment in surgeries related with ocular surface disorders, being an alternative to the use of amniotic membrane. The mPRGF accelerates tissue regeneration after ocular surface surgery thus minimizing inflammation and fibrosis.