Eyeworld

83 EW CORNEA by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer Case study report supports the implementation of plasma rich in growth factors (PRGF) for the management of severe dry eye, with benefits that extend beyond reducing dry eye symptoms S teroids and lubricants may ameliorate dry eye symptoms, but they do not address the root of the problem. Healing the cornea, particularly in the presence of advanced ocular surface disease (OSD), requires a different approach and is far more beneficial for eye health and good vision. According to a case study presented at the 22nd ESCRS Winter Meeting, plas- ma rich in growth factors (PRGF) may represent an effective means to handle dry eye in these patients. Reversing dry eye and ocular surface disease September 2018 Slit lamp exam showed intense punctate keratopathy in both eyes and filamentary keratitis in the left eye. Source: Merce Morral, MD, PhD continued on page 84 When steroids aren't enough The case was presented by Merce Morral, MD, PhD, Instituto de Mi- crocirurgia Ocular, Barcelona, Spain, who described a 62-year-old female patient who had been suffering from severe dry eye for 20 years. The patient had primary biliary cirrhosis and secondary Sjögren's syndrome. She came to Dr. Morral's clinic with complaints of intense photophobia and a foreign body sensation in her eyes. Severe ocular surface disease was noted upon examination, with clinically significant cataract in both eyes. The patient had Fuchs' endo- thelial dystrophy and a history of cyclosporine 0.05% intolerance. The patient was a high hyper- ope (+7.00) with a corrected visual acuity (CDVA) of 0.2 (right eye) and 0.5 (left eye). Her IOP was 14 mm Hg and aqueous tear secretion was significantly reduced (Schirmer's test: 4 mm right side, 0 mm left). The slit lamp exam revealed fila- ments with fluorescein staining, with the meibomian glands, howev- er, within normal limits. Dr. Morral was faced with the dilemma of deciding how to ap- proach management. "What we had to do first was improve the ocular surface, knowing that it was likely to worsen after the surgery," Dr. Morral explained. "Secondly, we needed to manage the ocular surface because ocular surface disease can affect IOL power calculations. Cataract surgery can only be performed when the ocular surface is taken care of. This patient had some serious symptoms associated with dry eye, including significant ocular surface inflamma- tion, severe aqueous deficiency, and filamentary keratitis." The treatment began with topical steroids and diverse lubri- cants and a vitamin A ointment at bedtime. Although the patient had a significant symptomatic improve- ment 2 months later, Dr. Morral could note no change in ocular surface disease when she examined the patient by slit lamp. She add- ed PRGF (Endoret), a technology developed by the BTI Biotechnology Institute of Spain, into the treat- ment mix at this point, prescribing drops four to five times per day, in addition to the previously prescribed regimen. Two months after the addition of plasma rich in growth factors, there was a significant im- provement in both symptoms and ocular surface signs. Dry eye is a multifactorial disease of the ocular surface char- acterized by a loss of homeostasis of the tear film and accompanied by ocular symptoms in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnor- malities play etiological roles. One study that investigated PRGF effects on wound healing and haze forma- tion after PRK surgery in mice found that PRGF stimulated the prolifer- ation and migration of epithelial cells, allowing regeneration, corne- al wound healing, and a reduced haze formation. 1 Another study by the same investigative team that reviewed the technology of PRGF in ocular surface disorders found its use Presentation spotlight

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