Subconjunctival And Intrastromal Application Of Platelets-Rich Plasma (Prp)Along Stromal Lenticule In Corneal Perforations Due Severe Dry Eye Disease-Case Report

Purpose: The objective of this study is a brief overview of the new  methods of  application of PRP (subconjunctival and instrastromal injections) and stromal lenticule in patient with spontaneous corneal perforation due to severe dry eye disease. We preferred this route of application of PRP to administer stem cells, as they can increase the concentration of growth factors in the deep layers of the cornea in a minimally invasive way.

Department of Ophthalmology,Prishtina

Republic of Kosovo

Methods: We report a case of paracentral corneal perforation due to the severe form of the dry eye. Even despite the usual therapy applied, there was a delay in closing the defect. In this case we applied a method combined with the defect closure using the stromal lenticule as well as autolog PRP.The stromal lenticule was extracted by SMILE surgery on the day of corneal perforation repair surgery. The surgery was performed using a 120 μm cap thickness, a 8.0 mm cap diameter, a 6.5 mm lenticule diameter and a 120° side-cut angle. Lenticule donors with corrected spherical equivalents of 6 diopters or more had been selected in order to be able to obtain a stromal lenticule thickness of more than 100 μm. Using nylon 10-0 with spatula needle, 4 interrupted sutures were performed to connect the lenticule to the surrounding conjunctiva tissue.PRP plasma used at same time subconjunctival 0.5 ml and intrastromal 0.3 ml at same day of corenal repair.PRP plasma was use after that every 2 weeks for 3 months.

Result: The  follow-up period range 3-6  months. On the first postoperative day, the patient experienced a mild foreign body sensation, and slit-lamp examination showed a well-positioned graft with intact sutures. Complete epithelialization was attained within the first week. Three months after surgery, the corneal sutures were removed and  the graft in a right position.The patient was then assessed every month for 6 months with BCVA, IOP, AS-OCT ,corneal topograhy and pachymetry.

Conclussion: It can be concluded from this study that the therapeutic response with subconjunctival and intrastromal injection of PRP was actually satisfactory in corneal perforations in severe  dry eye cases with corneal perforation. This case also suggested that the stromal lenticule, with its biocompatibility, sufficient strength, ease of handling and low cost, is a useful patch graft for various therapeutic purposes in the ophthalmic field. These combine procedures were seen as hopeful in other diseases such as chemical burns, corneal dystrophy,keratoconus dieases .Application of PRP  has been the subject of many studies in the different field of medicine to stimulate tissue healing and regeneration.