Mercado Carolina, Hernández Cesar, Lopez-Rojas Carolina, De La Sen-Corcuera Borja, Anitua Eduardo, Barraquer José Ignacio, Gutiérrez Angela, Otero Ernesto, Sabater Alfonso L
Escuela Superior de Oftalmología, Instituto Barraquer de América, Bogota, Colombia.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States.
Front Med (Lausanne). 2024 Aug 12;11:1368117. doi: 10.3389/fmed.2024.1368117. eCollection 2024.
BACKGROUND/AIMS: Corneal endothelial cell loss contributes to transplant failure. Autologous plasma products (APP) activate salvaging pathways that can prevent oxidative stress perioperatively. This study aimed to evaluate the safety of intraoperative incubation of full-thickness corneal grafts in platelet-rich plasma (aPRP) and plasma rich in growth factors (PRGF-Endoret) in mitigating postoperative corneal endothelial cell loss (ECL).
Pilot study including patients undergoing penetrating keratoplasty (PK) for various indications between June 2021 and December 2022. Patients were randomly assigned to receive either aPRP or PRGF-Endoret incubation, while those who declined intervention served as the control group. Demographic and clinical data were collected, including preoperative and postoperative endothelial cell count, intraocular pressure, pachymetry, and adverse reactions.
Thirty individuals who underwent PK completed follow-up: eight from the aPRP group, 10 from the PRGF-Endoret group, and 12 from the control group. No adverse events related to APP treatment were recorded. In the first and third postoperative months, the APP group had significantly lower ECL percentages (37% vs. 25%, = 0.02, and 44% vs. 33%, = 0.02, respectively); this trend was maintained in the sixth month. When stratified, the PRGF-Endoret group showed significant differences in ECL reduction compared to controls at both time points ( = 0.03 and = 0.05, respectively). The aPRP group showed a similar statistically significant outcome exclusively on the third postoperative month ( = 0.04). APP tended to reduce corneal edema faster than controls. Hexagonality was significantly better in the APP groups in the first and third months, particularly in the PRGF-Endoret group ( < 0.005).
Preoperative incubation with APP is safe and promotes better endothelial cell quality and quantity in the early postoperative period following PK. These findings suggest a potential clinical benefit in enhancing graft outcomes and warrant further investigation.
背景/目的：角膜内皮细胞丢失会导致移植失败。自体血浆制品（APP）可激活挽救途径，预防围手术期的氧化应激。本研究旨在评估在富血小板血浆（aPRP）和富含生长因子的血浆（PRGF-Endoret）中对全层角膜移植片进行术中孵育，以减轻术后角膜内皮细胞丢失（ECL）的安全性。
前瞻性研究，纳入2021年6月至2022年12月因各种适应证接受穿透性角膜移植术（PK）的患者。患者被随机分配接受aPRP或PRGF-Endoret孵育，而拒绝干预的患者作为对照组。收集人口统计学和临床数据，包括术前和术后的内皮细胞计数、眼压、角膜厚度测量和不良反应。
30例接受PK的患者完成随访：aPRP组8例，PRGF-Endoret组10例，对照组12例。未记录到与APP治疗相关的不良事件。在术后第1个月和第3个月，APP组的ECL百分比显著更低（分别为37%对25%，P = 0.02；44%对33%，P = 0.02）；这一趋势在第6个月得以维持。分层分析时，PRGF-Endoret组在两个时间点的ECL减少情况与对照组相比均有显著差异（分别为P = 0.03和P = 0.05）。aPRP组仅在术后第3个月显示出类似的统计学显著结果（P = 0.04）。APP组角膜水肿消退速度往往比对照组更快。在第1个月和第3个月，APP组的六边形细胞比例显著更好，尤其是PRGF-Endoret组（P < 0.005）。
PK术前用APP孵育是安全的，并能在术后早期促进更好的内皮细胞质量和数量。这些发现提示在改善移植效果方面具有潜在临床益处，值得进一步研究。
