Clinical Sciences |

Autologous Fibrin Membrane Combined With Solid Platelet-Rich Plasma in the Management of Perforated Corneal Ulcers:  A Pilot Study

Jorge L. Alio, PhD; Alejandra E. Rodriguez, MSc; Lorena M. Martinez, MD; Alvaro Luque Rio, MSc
JAMA Ophthalmol. 2013;131(6):745-751. doi:10.1001/jamaophthalmol.2013.2474.
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Importance The combined use of autologous fibrin membrane and the eye platelet-rich plasma (E-PRP) clot could be considered as a new surgical alternative for the closure of corneal perforations.

Objective To evaluate the use of autologous solid platelet-rich plasma in combination with an autologous fibrin membrane as a surgical alternative for wound closure in perforated corneal ulcers.

Design Both the fibrin membrane and the E-PRP clot were prepared with the patient's own blood just before the operation. Nylon stitches were used to fixate the fibrin membrane to the conjunctiva and then the E-PRP clot was placed over the corneal perforation, underneath the fibrin membrane. A temporal partial tarsorrhaphy was performed at the end of the procedure. We conducted postoperative monitoring for 3 months.

Setting Vissum Corporacion Oftalmologica, Alicante, Spain.

Participants Eleven patients with perforated corneal ulcers.

Intervention Surgical alternative for the closure of corneal perforation.

Main Outcomes and Measures Corneal biomicroscopy, fluorescein test, digital tonometry.

Results In all cases the corneal perforation was sealed. The fibrin membrane was present over the corneal surface for the first 3 to 5 days and then gradually disappeared. No evidence of infection or inflammation was detected. Digital tonometry confirmed acceptable levels of ocular tonus in all cases from day 2 after the operation. No patients reported pain, discomfort, or other symptoms, and no complications were observed. After 3 months' follow-up, there was no evidence of relapses or perforations. Corneal grafting was eventually performed in 7 of the 11 cases.

Conclusions and Relevance The combined use of autologous fibrin membrane and E-PRP clot is a safe and effective surgical alternative for the closure of corneal perforations. This technique can be considered as a temporary measure until the condition of the cornea permits definite intervention.

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Figure 1. The shape and size of the fibrin membrane immediately after its preparation.

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Figure 2. Intraoperative steps of the surgical technique. A, Large central corneal perforation (patient 2). B, The fibrin membrane is extended over the perforated cornea and sutured to the inferior conjunctiva. C, The eye platelet-rich plasma (E-PRP) clot is placed underneath the fibrin membrane. The E-PRP is the yellowish mass (arrow). D, The upper portion of the membrane is sutured to the conjunctiva.

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Figure 3. The aspect of partial remains of the fibrin membrane over the corneal surface 8 days after the operation (patient 7).

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Figure 4. Patient 1, who had a history of penetrating keratoplasty and corneal graft rejection. A, Central corneal perforation (arrow). B, Intraoperative aspect of the cornea.

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Figure 5. Patient 8, who had Fuch dystrophy and corneal perforation. A, The visible material at the ulcer level is necrotic epithelium with discharge. Positive spontaneous Seidel test was evident in the examination. B, Postoperative aspect of the same eye 15 days after surgery. C, Fluorescein stain in the same eye. Corneal inflammation was reduced significantly, maintaining stable stromal thinning.




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