Platelet-rich plasma combined with amniotic membrane graft versus fibrin glue alone for the treatment of perforated infectious central corneal ulcer

Abstract

Purpose The aim of this work is to evaluate the safety and efficacy of combined use of topical platelet-rich plasma (PRP) − PRP clot and eye drops − and amniotic membrane graft (AMG) for the management of microbial central corneal perforations and compare the results with fibrin glue (FG) application alone. Patients and methods This is a comparative retrospective clinical cohort study. Thirty-six eyes with microbial perforated central corneal ulcer were included. These eyes were classified into two groups each of 18 eyes. In group A, the eyes were treated by AMG combined with PRP clot to seal the central corneal perforation followed by PRP eye drops six times per day. In group B, the eyes were treated by FG only. Results Most of the eyes had anterior chamber formation within 24 h; 94.4 and 66.7% in groups (A and B), respectively, with statistically significant difference ( P =0.035), stability of the graft was achieved in all eyes of group A. Complete resolution of microbial perforated corneal ulcer was achieved in 17 (94.4%) eyes in group A compared to 14 (77.8%) eyes in group B with statistically significant difference ( P <0.05). Posttreatment complications were found in four (22.2%) cases in group A, they were significantly lower than group B, found in eight (44.4%) cases where P value less than 0.001. Conclusion The combined use of AMG and topical PRP were found to be more effective and safer than the application of FG alone for the treatment of central microbial corneal perforation. We recommend using PRP as an adjuvant therapy to AMG for treating medium-sized corneal perforations postmicrobial keratitis, however, the study has some limitations as the limited number of cases. Also, more comparative and prospective studies are recommended on a large scale for more evaluation of the outcome and complications.