Autologous serum eye drops versus lacrimal gland injection of platelet-rich plasma for severe dry eye

Abstract

Aim The aim of this study was to evaluate the use of autologous serum (AS) eye drops versus lacrimal gland injection of platelet-rich plasma (PRP) in the treatment of severe dry-eye disease (DED).Setting and design This is a prospective comparative interventional study that was carried out at Eye Tech Centre, Alexandria, Egypt.Patients and methods The study included 40 eyes of 20 patients with severe DED. They were randomized into two groups: group A received lacrimal gland injection of PRP transcutaneously into the external one-third of the orbital rim at a depth of 4 mm to the superior area on days 0, 30, 60, and 90, while group B received AS eye drops five times daily for the duration of the study. Both groups received preservative-free artificial tears eye drops (hyaluronic acid) —three to five times daily for the study duration. The patients were followed up for 12 weeks after the first injection or the initiation of AS eye drops for the subjective changes in symptoms and in ocular surface parameters.Results The patients’ age ranged from 46 to 71 years (mean=56.0±8.2 years). Both groups showed a significant improvement of dry-eye symptoms (P<0.05) using the Ocular Surface Disease Index scoring with group B having more significant improvement of symptoms compared with group A patients after 3 months of follow-up (P<0.05). Schirmer’s test I showed a statistically significant improvement in both groups over the follow-up period (P<0.05), with no statistically significant difference between the two groups after 3 months (P>0.05). The other ocular surface parameters, using the ocular surface analyzer, including the noninvasive tear breakup time, tear-meniscus height, and lipid-layer thickness, showed significant improvement in both groups (P<0.001), while the meibomian gland loss area showed no statistically significant change throughout the follow-up period, with no statistically significant difference between the two groups after 3 months (P>0.05).Conclusions Both AS and lacrimal gland injection of PRP proved the safety and efficacy in the treatment of severe DED and were comparable. More studies are needed to confirm these results.