Treatment of Ocular cGVHD with PRP: a confocal microscopy study

Abstract

Purpose: Graft versus host disease (GVHD) is a sequela of allogenic hematopoietic stem cell transplantion (allo-SCT) which results from a donor-origin cellular response against host tissues. It involves the cornea, the conjunctiva, the lacrimal glands, the lids and the sclera and quality of life can be seriously impacted. The aims of the treatment is the resolution of the inflammation and the maintaining of the integrity of the ocular surface. The aim of our study is to verify the efficacy of platet rich plasma eye drop in patients with cGVHD ocular manifestations.

Methods: 20 patients treated with one drop 5 time a day for 3 month. Patients underwent a completed ocular exam, a rated subjective assesment and a confocal microscopy (Confoscan 3). Preparation of PRP: 10 ml of platelet rich plasma (PRP) were obtained from 16 ml of autologous peripheral blood into two REGEN ™ RTHT tubes after centrifugation 8 minutes at 1500xg. It’s possible to variate PRP volume transferring in another tube then draw off 2 ml supernatant after centrifugation and homogenize by inversion of the tube. In this way the platelet number can reach twice or three times greater than peripheral values. Platelet gel was performed adding PRP 5 ml of autologous serum plus 2 ml of Ca-gluconate.

Results: 15 out of 20 patients achieved an important subjective improvement after 3 months therapy; a better sub-epithelial nervus plex trophism was demonstrated in these microscopy with a clear disminution of keratocytic activation. 3 patients showed symptomatic improvements just during the PRP administration. The last 2 patients did not show any improvement, although a decrease of inflammatory cells was verified with confocal microscopy exam.

Conclusions: This study proves that PRP is an effective ocular therapy which improved our patients quality of life and their corneal trophism, even after the conclusion of therapy. Finally, it seems that PRP play a modulation role on inflammatory cells of ocular surface.

Keywords: 621 ocular irritants • 596 microscopy: confocal/tunneling • 484 cornea: stroma and keratocytes