**8. Conclusions**

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

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

The two main methods of obtaining platelets are by autologous donation and by the technique of platelet apheresis. The advantage of the apheresis technique is that the platelet concentration is higher in the final concentrate and should contain at least 5.5 × 10 10 platelets, while its disadvantage is the cost that is extremely superior to the autologous total donation technique [48]. In the apheresis technique for platelet collection, Rezende et al. used the Haemonetics MCS + 9000 automatic cell separator and the 995-E apheresis-specific kit (Haemonetics Corp.). In that system, by means of a venipuncture, the blood of the patient himself is drained to a separation device. An optical refraction analyzer separates the platelet layer, and the remaining blood is completely returned to the patient, determining the end of a cycle. Sodium citrate can be used as an anticoagulant in the ratio of 1 to every 9 ml of whole blood processed. In 2 cycles, 72 ml of platelet concentrate was collected; the hematimetric indices of the patient and also the platelet concentrate indices are evaluated before and after the procedure (Coulter AcT Diff) [81].

time of instillation [90].

use compared to all the hemoderivates in dry eye.

**7. The methods of obtaining platelet-rich plasma**

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

28 Plasma Medicine - Concepts and Clinical Applications

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 therapy. However, randomized clinical trials are needed so that standardized protocols for the production, storage, and use of this therapy should be created. Prospective studies should also be conducted to evaluate these long-term outcomes.

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