**6. The use of PRP in ophthalmology**

PRP has been reported in corneal ulcers [80–82], in chemical burns [83, 84], in restoration of lacrimal function [85], in blepharoplasties surgeries [86], in ocular surface syndrome after refractive surgeries [44], and in graft-versus-host disease [87].

**Figure 2.** Before and after treatment with PRP in patient with diabetic dry eye.

The Use of Platelet-Rich Plasma in Dry Eye Disease http://dx.doi.org/10.5772/intechopen.76090 27

**Figure 3.** Before and after treatment with PRP in patient with diabetic dry eye.

**Figure 4.** Before and after treatment with PRP in patient with diabetic dry eye.

In dry eye, there are few studies reporting the use of PRP. Alio et al., in 2007, evaluated 18 symptomatic patients that used this treatment for 1 month and observed that symptoms of dry eye improved in 89% of patients, that conjunctival injection was present in 38.9% of patient, that 86% of the symptoms decreased, that lachrymal meniscus improved in 56% of the cases, and that corneal staining also decreased. In impression cytology increase in conjunctival goblet cells was observed [88].

Ribeiro et al., had studied about diabetic dry eye patient. They evaluated 12 patients with grades 2–4 of severity [8, 12]; 41.67% had a reduction in Schirmer's gradation, 58.33% had an increase in TFBUT (tear film breakup time), visual acuity improved in 41.66% of patients, and OSDI questionnaire score significantly improved in 100% of patient. The authors also found that before treatment, 91.67% had severe dry eye and after treatment, 50% were classified as normal, 25% as mild dry eye, 16.66% as moderate dry eye, and just one patient had instead a severe dry eye (**Figures 1**–**5**) [89].

**Figure 1.** Before and after treatment with PRP in patient with diabetic dry eye.

**Figure 2.** Before and after treatment with PRP in patient with diabetic dry eye.

In dermatology, PRP has been used for wound healing of acne scars [69], vitiligo [70], venous ulcers [71], alopecia [72], skin rejuvenation [73], and some cases of lichen sclerosus [74].

In gynecology, there are studies where PRP had been used in cases of infertility [75], in uterine prolapse [76], in inducing endometrium proliferation [75], and in scars of cesarean sections [77]. It has also been used in otolaryngology [78], in urinary diseases [79], and in other medical

PRP has been reported in corneal ulcers [80–82], in chemical burns [83, 84], in restoration of lacrimal function [85], in blepharoplasties surgeries [86], in ocular surface syndrome after

In dry eye, there are few studies reporting the use of PRP. Alio et al., in 2007, evaluated 18 symptomatic patients that used this treatment for 1 month and observed that symptoms of dry eye improved in 89% of patients, that conjunctival injection was present in 38.9% of patient, that 86% of the symptoms decreased, that lachrymal meniscus improved in 56% of the cases, and that corneal staining also decreased. In impression cytology increase in con-

Ribeiro et al., had studied about diabetic dry eye patient. They evaluated 12 patients with grades 2–4 of severity [8, 12]; 41.67% had a reduction in Schirmer's gradation, 58.33% had an increase in TFBUT (tear film breakup time), visual acuity improved in 41.66% of patients, and OSDI questionnaire score significantly improved in 100% of patient. The authors also found that before treatment, 91.67% had severe dry eye and after treatment, 50% were classified as normal, 25% as mild dry eye, 16.66% as moderate dry eye, and just one patient had instead a

specialties.

**6. The use of PRP in ophthalmology**

26 Plasma Medicine - Concepts and Clinical Applications

junctival goblet cells was observed [88].

severe dry eye (**Figures 1**–**5**) [89].

refractive surgeries [44], and in graft-versus-host disease [87].

**Figure 1.** Before and after treatment with PRP in patient with diabetic dry eye.

**Figure 3.** Before and after treatment with PRP in patient with diabetic dry eye.

**Figure 4.** Before and after treatment with PRP in patient with diabetic dry eye.

Platelet growth factors were generally obtained in a ranked room; hence, the handling of platelet concentrate was performed within a Category II-Type A biological safety cabinet. Then, 2800 microliters of 10% calcium chloride was added, and the final product was maintained at +37°C for approximately 30 min. Subsequently, the unit was subjected to centrifugation (900G), and the supernatant serum, which contained the platelet growth factors, was transferred to four 50 ml falcon-type tubes (Becton-Dickinson) and maintained at −80°C (Revco). Research of bacteria, aerobic and anaerobic, and fungal agents was performed in a

The Use of Platelet-Rich Plasma in Dry Eye Disease http://dx.doi.org/10.5772/intechopen.76090 29

The release of serum with platelet growth factors in the study by Rezende et al. was done as follows: weekly, thawed Falcon tube containing approximately 10 ml of autologous serum with platelet growth factors that was transferred to flasks, and the patient is advised to keep the biological medicine at a temperature below −10°C (freezer) and to unfreeze it naturally

Alio et al. used the autologous donation technique to obtain platelets, when patients were submitted to venipuncture and 80–100 ml of blood were collected in sterile 10 ml tubes containing 1 ml of sodium citrate to avoid coagulation. These tubes were left at room temperature for 10 min, and only the supernatant (upper tube fraction) was collected as the final product. The platelet concentrate was then prepared under sterile conditions in a laminar flow room. Two to three milliliters of this concentrate was then placed in sterile eyedrops. The eyedrops were kept at −20°C, and only when the patient was going to use an eyedrop bottle, thaw it and then keep it at +4°C, discarding that bottle at the end of a week, when a new one is thawed.

Both methods require the patient to perform an autologous blood donation. Autologous blood does not transmit disease; there is no occurrence of hemolytic (alloimmunization), allergic, immunological (immunomodulation), or acute lung injury by transfusion and common com-

The contraindications for autologous donations are anemia or other types of pathological hemodilution; conditions that lead to oxygen saturation and hemoglobin saturation (less than 11 mg/dl); hepatopathies; nephropathies; coagulopathies; hemoglobinopathies; decompensated heart diseases; and presence of infectious diseases such as Chagas, syphilis, HIV, HTLV, hepatitis B and C, and others transmissible by blood considered as "relative" contraindications, since the patient will receive the same, but there may be contamination of the health team in the handling of that blood. In HIV, there may be reactivation of the virus when reinfused [91, 92]. Complications of autologous donation are those inherent to a donor, such as hypotension,

It can be concluded from these studies that the therapeutic response with PRP was actually satisfactory in severe or moderate dry eye cases which do not respond to conventional

The patients were advised to use these eyedrops four times a day for 1 month [88].

anemia, angina, and contamination of the material of the blood bags [91].

systematic way.

immediately before each use [81].

plications in heterologous donations [91].

**8. Conclusions**

**Figure 5.** Before and after treatment with PRP in patient with diabetic dry eye.

Recently, in 2017, Alio reported a 368-patient prospective, interventional nonrandomized study, where moderate to severe dry eye was included. The results were as follows: Schirmer's test value had a significant improvement, subjective symptoms had an improvement in 87.5% of patients, OSDI scores were statistically significant, 28.8% experienced an increase of one or more lines of vision, decrease in corneal fluorescein staining was observed in 76.1% of patients, and only one patient reported intolerance to the use of PRP due to discomfort at the time of instillation [90].

Another alternative that has been reported in dry eye treatment is the plasma rich in growth factors (PRGF). Lopez-Plandolit et al. observed that PRGF treatment was associated with improvement in score dry eye questionnaire values and as results from impression cytology. In 75% of patients, no further medication was required. But squamous metaplasia did not reduce significantly [49]. It is very similar to PRP; however, there are no researches in human use compared to all the hemoderivates in dry eye.
