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Ignacio Rodriguez-Agirretxe, Elio Diez-Feijoo, Arantxa Acera, Vanessa Freire, Jose Ignacio Recalde, Arrate Onaindia; Wound healing modulation in glaucoma filtering surgery with plasma rich in growth factors: a case series study. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3198.
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© ARVO (1962-2015); The Authors (2016-present)
Plasma rich in growth factors (PRGF) is an autologous technology that, acting as an in situ delivery of multiple cellular modulators, has showed regenerative properties in different areas of medicine. The aim of this study is to evaluate its potential effect in wound healing modulation after glaucoma filtering surgery.
Seven consecutive patients with uncontrolled open-angle glaucoma underwent uncomplicated deep sclerectomy (DS) with implant. Preoperatively, blood samples were collected, centrifuged and whole plasma column was drawn of and activated to obtain a clot, which was placed in the subconjunctival space during the DS. Postoperatively, intraocular pressure (IOP), anterior segment OCT (AS-OCT) and bleb photography were performed at 1, 7, 30, 90 and 180 days after the DS. AS-OCT variables were the height of the bleb cavity (BC) and intrascleral lake (IL), conjunctiva/Tenon layer (CT) thickness and presence of microcysts. Bleb was evaluated according the Moorfields Grading System.
Comparing its preoperative values, the mean IOP was significantly reduced over the postoperative period (p<0.05 in all cases). At the end of the follow-up, the height of the BC, IL and CT were (0.1 ± 0.8 mm, 0.53 ± 0.14 and 0.36 ± 0.13 respectively). There were no microcysts 6 months after the DS. The blebs showed a mean area, height and vascularity corresponding to the grades 3.8 ± 0.4, 2.2 ± 0.4 and 2 respectively. There were no cases of bleb dysesthesia nor bleb related complications.
PRGF is an autologous technology that, as an adjuvant to glaucoma surgery, could promote the regeneration instead of scarring of the conjunctiva, leading to the formation of more physiological filtering blebs than those obtained when antimitotics are used. Moreover, its autologous nature prevents the potential transmission of microorganisms, potential risk of other treatments such as amniotic membrane transplantation.
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