Abstract
Purpose
The use of standard sutures has been replaced by platelet-rich plasma (PRP), a bioadhesive agent, in several surgical procedures. This prompted us to test PRP efficacy in experimental lamellar keratoplasty.
Methods
After lamellar anterior keratoplasty, PRP with a mean concentration of 807 564 platelets/mm3 was used to attach the corneal flap to the stromal surface in 12 New Zealand white rabbits. 10-0 nylon sutures were used in one control group of 12 animals and no suture was used in a second control group of six rabbits. Animals were killed at days 2, 7, 30, and 90 for histological and smooth muscle actin (SMA) immunohistochemical analysis.
Results
The PRP group showed a tight corneal graft from the first postoperative hours until they were killed. A transparent cornea was seen at 30 days and remained clear until the end of the protocol. Histological specimens showed no signs of ocular inflammation in any animal within the PRP group. Electron microscopy showed normal morphological features on the flap and stromal bed, and a clear interface zone without cells or debris. The number of stromal myofibroblasts was lower than that seen in the suture group at 3 months postsurgery. The sutured group showed an attached cornea with signs of inflammation around the knots. All flaps without PRP or sutures were completely detached in the immediate postoperative period.
Conclusions
PRP was useful for attaching the corneal flap and it was well tolerated by the rabbit corneal tissue. Corneal healing was satisfactory. Further studies on PRP adhesiveness in grafts with donor corneas should be performed before considering its use in patients.
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References
Terry MA . The evolution of lamellar grafting techniques over twenty-five years. Cornea 2000; 19: 611–616.
Christo CG, van Rooij J, Geerards AJM . Suture-related complications following keratoplasty: a 5-year retrospective study. Cornea 2001; 20: 816–819.
Webster Jr RG, Slansky HH, Refojo MF, Boruchoff SA, Dohlman CH . The use of adhesive for the closure of corneal perforations. Arch Ophthalmol 1968; 80: 705–709.
Sharma A, Kaur R, Kumar S, Gupta P, Pandav S, Patnaik B et al. Fibrin glue versus N-butyl-2-cyanoacrylate in corneal perforations. Ophthalmology 2003; 110: 291–298.
Eiferman RA, Snyder JW . Antibacterial effect of cyanoacrylate glue. Arch Ophthalmol 1983; 101: 958–960.
Spierer A, Barequet I, Rosner M . Reattachment of extraocular muscles using fibrin glue in a rabbit model. Invest Ophthalmol Vis Sci 1996; 38: 543–546.
Koranyi G, Seregard S, Kopp ED . Cut and paste: a no suture, small incision approach to pterygium surgery. Br J Ophthalmol 2004; 88: 911–914.
O'Sullivan F, Dalton R, Rostron CK . Fibrin glue: an alternative method of wound closure in glaucoma surgery. J Glaucoma 1996; 5: 367–370.
Lee KH, Kim MS, Hahn TW, Kim JH . Comparison of histological findings in wound healing of rabbit scleral homografts with fibrin glue (TisseelR) and suture material. J Refract Surg 1995; 11: 397–401.
Kim JC, Bassage SD, Kempski MH, del Cerro M, Park SB, Aquavella JV et al. Evaluation of tissue adhesives in closure of scleral tunnel incisions. J Cataract Refract Surg 1995; 21: 320–325.
Goins KM, Khadem J, Majmudar PA, Ernest JT . Photodynamic biologic tissue glue to enhance corneal wound healing after radial keratotomy. J Cataract Refract Surg 1997; 23: 1331–1338.
Kaufman HE, Insler MS, Ibrahim-Elzembely HA, Kaufman SC . Human fibrin tissue adhesive for sutureless lamellar keratoplasty and scleral patch adhesion. Ophthalmology 2003; 110: 2168–2172.
Eppley BL, Woodell JE, Higgins J . Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg 2004; 114: 1502–1508.
El-Sharkawy H, Kantarci A, Deady J, Hasturk H, Liu H, Alshahat M et al. Platelet-rich plasma: growth factors and pro- and anti-inflammatory properties. J. Periodontol 2007; 78: 661–669.
Carlson NE, Roach Jr RB . Platelet-rich plasma: clinical applications in dentistry. J Am Dent Assoc 2002; 133: 1383–1386.
Grageda E . Platelet-rich plasma and bone graft materials: a review and a standardized research protocol. Implant Dent 2004; 13: 301–309.
Man D, Plosker H, Winland-Brown JE . The use of autologous platelet-rich plasma (platelet gel) and autologous platelet-poor plasma (fibrin glue) in cosmetic surgery. Plast Reconstr Surg 2001; 107: 229–237.
Christenson JT, Kalangos A . Autologous fibrin glue reinforced by platelets in surgery of ascending aorta. Thorac Cardiovasc Surg 2004; 52: 225–229.
Silberstein LE, Williams LJ, Hughlett MA, Magee DA, Weisman R . An autologous fibrinogen-based adhesive for use in otologic surgery. Transfusion 1988; 28: 319–321.
Alio JL, Colecha JR, Pastor S, Rodriguez A, Artola A . Symptomatic dry eye treatment with autologous platelet-rich plasma. Ophthalmic Res 2007; 39: 124–129.
Alio JL, Abad M, Artola A, Rodriguez-Prats JL, Pastor S, Ruiz-Colecha J . Use of autologous platelet-rich plasma in the treatment of dormant corneal ulcers. Ophthalmology 2007; 114: 1286–1293.
Luengo Gimeno F, Gatto S, Ferro J, Croxatto JO, Gallo JE . Preparation of platelet-rich plasma as a tissue adhesive for experimental transplantation in rabbits. Thromb J 2006; 4: 18.
Polack FM . Lamellar keratoplasty, Malbran's peeling off technique. Arch Ophthalmol 1971; 86: 293–295.
Hayat MA . Basic Techniques for Transmission Electron Microscopy 1986.
Coons AH . Fluorescent antibody methods. In:Danielli JF (eds) General Cytochemical Methods. Academic Press: New York, 1958 pp 399–422.
Andreoni G, Angeretti N, Lucca E, Forloni G . Densitometric quantification of neuronal viability by computerized image analysis. Exp Neurol 1997; 148: 281–287.
Wilson SE . Analysis of the keratocyte apoptosis, keratocyte proliferation, and myofibroblast transformation responses after photorefractive keratectomy and laser in situ keratomileusis. Trans Am Ophthalmol Soc 2002; 100: 411–433.
Wilson SE, Netto M, Ambrosio Jr R . Corneal cells: chatty in development, homeostasis, wound healing, and disease. Am J Ophthalmol 2003; 136: 530–536.
Stark W, Taylor H, Stark WJ, Taylor HR, Bias WB, Maumenee AE . Histocompatibility (HLA) antigens and keratoplasty. Am J Ophthalmol 1978; 86: 595–604.
Trowbridge CC, Stammers AH, Woods E, Yen BR, Klayman M, Gilbert C . Use of platelet gel and its effects on infection in cardiac surgery. J Extra Corpor Technol 2005; 37: 381–386.
Alio JL, Abad M, Artola A, Rodriguez-Prats JL, Pastor S, Ruiz-Colecha J . Use of autologous platelet-rich plasma in the treatment of dormant corneal ulcers. Ophthalmology 2007; 114: 1286–1293.
Acknowledgements
This work was supported by grants from Pan-American Association of Ophthalmology and Austral University. We are grateful to Germán Ruffolo, Guillermo Gastón, Isabel Farias, and Nora Torry for their skilful technical assistance.
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Part of this work was presented at the ARVO Annual Meeting and at the AAO Annual Meeting in 2004
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Gimeno, F., Gatto, S., Croxatto, J. et al. In vivo lamellar keratoplasty using platelet-rich plasma as a bioadhesive. Eye 24, 368–375 (2010). https://doi.org/10.1038/eye.2009.49
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DOI: https://doi.org/10.1038/eye.2009.49
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