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Sequential anterior segment photographs of a case. (a) Primary nasal pterygium, swollen on the limbal site, infiltrates cornea 2 mm (arrow), and mild-moderate nasal conjunctival hyperemia. (b) PRF secured with separate 7/0 absorbable suture material on the bare sclera. Note the smooth transition between host conjunctiva and the membrane (arrows). (c) Postoperative first week slit-lamp examination. PRF dissolves, conjunctival epithelialization was completed, and limbal site was clear (arrow). (d) Postoperative sixth month slit-lamp examination. There was no recurrence, hyperemia, roughness, or other complications.
Source publication
PurposeTo compare the surgical results, complications, and recurrence rates of primary pterygium excision with conjunctival autografts (CA) vs platelet-rich fibrin (PRF) grafts.Patients and methodsA total of 35 eyes of 35 patients with primary pterygium were included in the study. The patients underwent excision of pterygium followed by closure of...
Contexts in source publication
Context 1
... to the quiescent results of the biomicroscopic evaluation performed 2 months after the medical treatment, no other procedure was applied to that patient. Figure 2 shows sequential anterior segment photographs of a case, taken preoperatively, intraoperatively, and on postoperative seventh day and sixth month. ...
Context 2
... to the quiescent results of the biomicroscopic evaluation performed 2 months after the medical treatment, no other procedure was applied to that patient. Figure 2 shows sequential anterior segment photographs of a case, taken preoperatively, intraoperatively, and on postoperative seventh day and sixth month. ...
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Citations
... To our knowledge, there are no studies of injectable PRF, while there are studies on pterygium surgery using the PRF membrane. Cakmak et al., instead of conjunctival autograft, covered the sclera with a PRF membrane and improved with a low recurrence rate [35]. Similarly, Yang et al. combined limbal stem cell transplantation with PRF application, achieving favorable outcomes with low recurrence rates [36]. ...
Objectives
To investigate the effects of subconjunctival injectable platelet-rich fibrin (i-PRF) injection on healing and complication rates after pterygium surgery with conjunctival autograft.
Methods
This retrospective and comparative study evaluated 31 eyes that received i-PRF injections under the donor and graft conjunctiva following pterygium surgery, while 34 eyes did not receive i-PRF after the pterygium surgery. The patients’ follow-up period was for 12 months. Postoperative recurrence, epithelial healing time, postoperative pain score, graft edema, and sliding of the graft (need for re-suturation) data were evaluated.
Results
For the 12 months after surgery, one eye (3.2%) in the i-PRF group had developed corneal recurrence, and five eyes (14.7%) in the non-i-PRF group had developed recurrence. The mean corneal epithelial healing time was 2.96 ± 0.70 days in the i-PRF group and 3.58 ± 0.70 days in the non-i-PRF group (p = 0.001). The mean healing time of the donor conjunctiva epithelium was 3.84 ± 0.70 days in the i-PRF group, whereas it was 4.44 ± 0.74 days in the non-i-PRF group (p = 0.006). The mean postoperative pain score was 4.45 ± 1.52 in the i-PRF group and 5.08 ± 1.40 in the non-i-PRF group. In the non-i-PRF group, three cases (8.8%) required re-suturation, whereas, in the i-PRF group, no one required re-suturation.
Conclusions
Thanks to its platelets-derived growth factors, i-PRF can be a safe and effective adjuvant therapy for faster healing of conjunctival autograft and in the prevention of recurrence.
... PRF provides a fibrin scaffolding matrix with numerous growth factors, biochemical activators and cellular glues that have been shown to enhance the healing and regeneration of tissues [11][12][13][14]. PRF is a biomaterial and orthobiologic agent that promotes optimal healing with an activated fibrin matrix that helps glue damaged tissues, thereby giving the injured tissue a scaffolding on which to build new tissue. ...
... The cases of ocular burns treated with injections of PRP and the PRF membrane with sustained release of growth factors and matrix proteins showed impressive results in two different situations (Case no. 1 and Case no. 6). Further studies showed good outcomes with PRP eye drops as a complement to the classical treatment and artificial tears [14]. Other treatment regimens using the pharmacologic regenerating agent (RGTA) showed success in neurotrophic ulcers for selected cases (33%) and failures in 67% of cases in six weeks [10]. ...
... PRF provides a fibrin scaffolding matrix with numerous growth factors, biochemical activators and cellular glues that have been shown to enhance the healing and regeneration of tissues [11][12][13][14]. PRF is a biomaterial and orthobiologic agent that promotes optimal healing with an activated fibrin matrix that helps glue damaged tissues, thereby giving the injured tissue a scaffolding on which to build new tissue. ...
... The cases of ocular burns treated with injections of PRP and the PRF membrane with sustained release of growth factors and matrix proteins showed impressive results in two different situations (Case no. 1 and Case no. 6). Further studies showed good outcomes with PRP eye drops as a complement to the classical treatment and artificial tears [14]. Other treatment regimens using the pharmacologic regenerating agent (RGTA) showed success in neurotrophic ulcers for selected cases (33%) and failures in 67% of cases in six weeks [10]. ...
Introduction: The aim of this study was to evaluate the use of highly concentrated platelet-rich plasma (PRP) subconjunctival injections, in combination with eye drops (eye PRP, or E-PRP), in treating dry eye disease (DED) and the use of platelet-rich fibrin (PRF) membrane in treating corneal burns and neurotrophic ulcers for the restoration of the homeostasis of the tear film and the morphology and function of the cornea.
Methods: We studied 16 patients (n=32 eyes) with severe DED. The disease was graded as severe according to the Oxford Grading Scale. There were 12 males (75%) and four females (25%) with a mean age of 56 years; these patients were treated with monotherapy, which involved a single subconjunctival injection of 0.2-0.3 mL of PRP prepared from autologous blood, followed by application of autologous PRP eye drops four times a day for 15 days between September 2019 and December 2020 in the same geographic area. All patients gave written informed consent before undergoing the outlined treatment protocol. We evaluated best corrected visual acuity (BCVA), Schirmer test score, tear film breakup time (TBUT) and corneal staining with fluorescein (Oxford Grading Scale) before and after six to eight weeks of treatment. Subjective normalization was defined by a decrease in the Ocular Surface Disease Index (OSDI) score to 10 or less, an objective normalization of the TBUT to five to six seconds, improvement in the Schirmer test score and Oxford grading and the BCVA gain of at least one line in the vision chart (Snellen chart). Furthermore, we report on the results from different variants of platelet concentrate-based treatments in five cases of corneal diseases: neurotrophic ulcers and corneal burns due to different causes (e.g., chemical burns) using E-PRP and PRF membrane with regard to normalization of morphology and function.
Results: The OSDI score decreased to normalization in 75% of the patients (p=6.545 × 10-15). TBUT was restored significantly in 20 of 32 eyes from 2.78±0.55 to 5.43±0.71 (p=1.612 × 10-24). The Schirmer test score showed an improvement from 4.46±0.67 to 10.28±1.18 (p=3.411 × 10-29), and BCVA improved by 43.75%, from 0.15±0.19 to 0.09±0.16 (logMAR, p=0.2331). Oxford grading changed to Scale I in 75% and Scale 0 in 25% of the patients. No complications or adverse reactions occurred in the five cases of corneal injuries. We observed a restoration of the morphology and function of the cornea with PRP injections or PRF+PRP application in 7-12 days, depending on the severity of the initial finding.
Conclusion: PRP treatment is a new approach in ophthalmology with impressive results. Although patients show good compliance and acceptance of the treatment protocol, studies with larger sample sizes are needed to confirm and optimize its use.
... Lower recurrence rates have been observed in methods where tissue grafts are applied to the scleral bed following pterygium excision. The conjunctival (CA) and CA-limbal, amniotic membrane, and platelet rich fibrin (PRF) membrane have been used as tissue grafts in pterygium surgery (2)(3)(4). At present, CA and limbal conjunctival autograft (LCA) techniques are the most commonly used techniques in pterygium surgery because of their lower recurrence rates. ...
... Cakmak et al. (4) first reported the application of a PRF membrane prepared in glass tubes in the surgical treatment of pterygium. In this study, 20 patients who underwent CA technique and 15 patients who underwent PRF membrane technique were compared in terms of recurrence rates, operation time, and complications, with follow-up periods ranging from 6 to 24 months. ...
... Įrodyta, kad su angiogeneze susiję veiksniai, tokie kaip CD31 ir kraujagyslių endotelio augimo faktorius (VEGF) yra labai išreikšti pterigiume, lyginant su jungine [5]. Pagrindinis pterigiumo progresavimo rizikos veiksnys -ilgalaikis saulės spindulių poveikis, kuris pažeidžia ląstelių proliferacijos ciklą ir sukelia patologinę ląstelių proliferaciją, plokščiųjų ląstelių metaplaziją, taurinių ląstelių hiperplaziją, uždegimą, fibrozę, angiogenezę ir ekstraląstelinio matrikso irimą [9]. Nors ligos patogenezė nėra žinoma, manoma, kad prie pterigiumo etiologijos prisideda ir lėtinis junginės uždegimas dėl karščio, sauso klimato, dulkių, vėjo bei oro taršos. ...
Pterigiumas yra gerybinis proliferacinis darinys, augantis iš bulbarinės junginės į rageną ir ant jos. Liga išsivysto dėl nekontroliuojamos ląstelių proliferacijos. Dažniausiai būna trikampio ar sparno formos ir susideda iš galvutės, kaklelio ir kūno. Pagrindinis rizikos veiksnys yra ilgalaikis saulės spindulių poveikis. Dažniausiai suserga 20–40 metų asmenys, kurie skundžiasi pablogėjusiu matymu bei diskomfortu. Vienintelis gydymo būdas – chirurginė operacija, kurios metu darinys pašalinamas, tačiau dažni recidyvų atvejai. Tyrimo tikslas – apžvelgti literatūros šaltiniuose aprašomą pterigiumo etiologiją, kliniką bei gydymo galimybes.
... All studies were randomized controlled trials aside from four prospective comparative studies. [10][11][12][13] Eight studies compared the use of fibrin glue versus sutures, 12,14-20 six studies compared CAU with fibrin glue to other treatment arms, 11,[21][22][23][24][25] and four studies compared CAU with sutures to other treatment arms. 10,13,26,27 In brief, the majority of studies harvested the CAU from the superotemporal quadrant of the bulbar conjunctiva, seven of which reported the use of conjunctival limbal autograft to include part of the superficial limbus. ...
... [10][11][12][13] Eight studies compared the use of fibrin glue versus sutures, 12,14-20 six studies compared CAU with fibrin glue to other treatment arms, 11,[21][22][23][24][25] and four studies compared CAU with sutures to other treatment arms. 10,13,26,27 In brief, the majority of studies harvested the CAU from the superotemporal quadrant of the bulbar conjunctiva, seven of which reported the use of conjunctival limbal autograft to include part of the superficial limbus. 10,12,13,17,18,24,27 Aside from one study that reported the use of autologous fibrin glue, 20 the fibrin glues used in the studies were commercially available products such as Tisseel ® (Baxter Healthcare Corporation, Glendale, CA) and FIBINGLURAAS ® (Shanghai RAAS Blood Products Co., Ltd, China). ...
... 10,13,26,27 In brief, the majority of studies harvested the CAU from the superotemporal quadrant of the bulbar conjunctiva, seven of which reported the use of conjunctival limbal autograft to include part of the superficial limbus. 10,12,13,17,18,24,27 Aside from one study that reported the use of autologous fibrin glue, 20 the fibrin glues used in the studies were commercially available products such as Tisseel ® (Baxter Healthcare Corporation, Glendale, CA) and FIBINGLURAAS ® (Shanghai RAAS Blood Products Co., Ltd, China). In the majority of the studies assessing CAU with sutures, the graft was anchored to the episclera and attached to the adjacent conjunctiva with interrupted 8-0 Vicryl sutures or 10-0 nylon sutures. ...
Purpose
To determine the health economic opportunity cost or gain associated with performing pterygium excision surgery using the TissueTuck technique with cryopreserved amniotic membrane (AM) instead of conjunctival autograft (CAU).
Methods
We performed a literature review to determine the average surgical duration of pterygium surgery using CAU with fibrin glue or sutures to calculate the average time saved with the TissueTuck technique. Such time savings was then used to determine the opportunity revenue gain per national average Medicare reimbursement if adjusted to the average surgical duration of cataract surgery.
Results
The time savings achieved using the TissueTuck technique over CAU with fibrin glue is 8.9 min per procedure, which can be applied to additional MSICS or phacoemulsification procedures to generate an opportunity revenue gain of $1167 or $762 per 2022 National Average Medicare reimbursement, respectively. After subtracting the current list cost of AmnioGraft (ie, $645), the opportunity gain is $522 or $117 if the time saving is applied to the above procedures, respectively. Alternatively, the time savings achieved by using the TissueTuck technique over CAU with sutures is 23.4 min per procedure, which can be applied to additional MSICS or phacoemulsification procedures to generate an opportunity revenue gain of $3068 and $2004 per TissueTuck procedure or $2423 or $1359 when accounting for the list cost of AmnioGraft, respectively.
Conclusion
The TissueTuck surgical technique using cryopreserved AM for pterygium takes less time, has lower recurrence rates, and provides an opportunity gain compared to pterygium excision with CAU.
... 30,31 With all these available suture-less methods, sutures are still used in pterygium surgery as reported by many authors. 25,32,33 In this study, Vicryl ® 8/0 sutures were used to fix the conjunctival autograft in a series of pterygium patients, and the manifestations of postoperative ocular irritation were evaluated. The study did not aim to compare the results of suture fixed graft with other suture-less procedures such as the fibrin glue. ...
Background: Ocular irritation remains the main disadvantage of the sutured conjunctival graft after pterygium excision. Evaluation of the severity of these manifestations can be helpful for better patient counselling about the expected postoperative course.
Aim: To evaluate the manifestations of ocular irritation in patients treated by pterygium excision with sutured conjunctival autograft.
Setting: A prospective interventional case series that evaluated the postoperative manifestations of ocular irritation in pterygium patients.
Methods: Twenty-five pterygium patients were treated by pterygium excision with vicryl 8/0 sutured conjunctival autograft. The severity of postoperative foreign body sensation, pain, watering, and localised hyperemia involving the nasal conjunctival quadrant were evaluated, scored, and graded.
Results: The main reported symptom was foreign body sensation, with a mean grade of 1.9 ± 0.54 recorded 3 to 4 days postoperatively, which declined one week postoperatively to a mean of 1 ± 0.45. Mild to moderate tolerable symptoms were reported in 92% at the first postoperative visit with an average score of 5 ± 1.05, which declined to an average of 1.4 ± 0.52 at one week, with all the patients reporting minimal symptoms. At the end of the follow-up, the mean index of localised nasal conjunctival hyperaemia was 2.5 ± 0.39. Recurrence was recorded in one patient (4%). No other complications were encountered.
Conclusion: Sutured conjunctival autograft can be used safely with tolerable short-term minimal to moderate manifestations of ocular irritation with no significant complications.
... 21,22 The cellular origin of fibroblasts is not only remnants of embryonic origin but may arise from tissue-specific epithelial cells. 23 The phenomenon in which epithelial cells change their phenotype to fibroblastic cells following morphogenic pressure from damaged tissue is called Epithelial-Mesenchymal Transition (EMT), and it is a common feature of cancer cells. 8 EMT is a well-known mechanism that plays a role in the dispersion of cells during vertebrate embryogenesis and is also observed in adults during the repair of damaged tissue and also in the early stages of cancer metastasis. ...
... 8 EMT is a well-known mechanism that plays a role in the dispersion of cells during vertebrate embryogenesis and is also observed in adults during the repair of damaged tissue and also in the early stages of cancer metastasis. 23 EMT plays an important role in the pathogenesis of several eye diseases and is probably involved in cataracts in humans and mice and subretinal fibrosis after retinal detachment. On the contrary, it has been found that limbal epithelial corneal cells (LECs) also undergo EMT following exposure to air in vitro. ...
Pterygium is a bulbar conjunctival fibrovascular growth that crosses the limbus and extends onto the peripheral cornea, and in some cases leads to significant visual complications. The prevalence of this disease has been reported to be from 1.2% to about 40% in different parts of the world. Although there are various risk factors for pterygium, which include ultraviolet (UV) radiation, viral infection, hereditary factors, immune factors, aseptic inflammation, and environmental irritation, the pathogenesis of pterygium is mainly related to exposure to UV light. In addition to cosmetic problems, pterygium can lead to eye irritation, disrupt the transparency of cornea on the pupil area, and cause disorders such as corneal astigmatism and damage to the visual axis leading to vision impairment. In the last few years, the treatment of pterygium has been developed and various new solutions have been used. Surgery is the main treatment for pterygium. Various techniques such as Bare Sclera, Rotational Conjunctival Flap, Limbal Conjunctival Autograft, Amniotic Membrane Graft, and Free Conjunctival Autograft are used for the removal of pterygium. It also seems that the worrisome problem of recurrence has been significantly reduced with newer treatment methods. On the contrary, the use of auxiliary treatments such as mitomycin C, b-radiation, 5-fluorouracil, topical use of interferons, and Avastin are also effective in reducing the recurrence rate.
... The intrinsic incorporation of these factors within this scaffold allows their progressive and controlled release as the fibrin mesh degrades. PRF releases autologous growth factors gradually, resulting in a stronger and more durable effect of proliferation, differentiation, migration, and matrix synthesis by binding to specific cell-surface-receptor (Cakmak et al. 2017). ...
Highlights:
• Sodium hydroxide causing platelet rich fibrin stimulates limbal stem cell proliferation in chemical trauma.
• Limbal stem cell niche and influences limbal stemness was repaired by Platelet Rich Fibrin.
Abstract:
Chemical injuries of the eye produce extensive damage to the ocular surface and limbal stem cells, resulting in permanent unilateral or bilateral visual impairment. Alkali injuries occur more frequently than acid injuries. Platelets are a rich source of potential wound healing, promoting polypeptide growth factors. This study aimed to investigate the effect of platelet-rich fibrin (PRF) lysates on limbal stem cell proliferation, which was exposed to sodium hydroxide that resembled limbal stem cell deficiency due to chemical trauma. Confluent rabbit (Oryctolagus cuniculus) limbal stem cells wounded using 20µL of 0.00625 M sodium hydroxide (pH 13) were treated with platelet-rich fibrin lysates (PRF) (0, 5, and 10%). PRF lysates were prepared from peripheral rabbit blood according to Choukroun's method without using anticoagulant and foreign factors for platelet activation. The proliferation of limbal stem cells was measured by a 3-(4,5-dimethylthiazol-2-yl)-2.50 diphenyl tetrazolium bromide (MTT) colorimetric assay at 24, 48, and 72 hours after exposure to sodium hydroxide. Proliferation significantly increased limbal stem cells with PRF lysates 5% (p
... Pterygium is an inflammatory, degenerative, and benign fibrovascular hyperplasia of the conjunctiva that extends across the limbus onto the cornea [1,2]. Nasal location is more common than temporal but, occasionally, can occur in both directions [1]. ...
... Nasal location is more common than temporal but, occasionally, can occur in both directions [1]. Even though its pathogenesis is not well understood, it is mainly associated with environmental factors, being ultraviolet radiation the major risk factor, which causes oxidative stress and hinders the normal cell proliferation cycle [1][2][3]. Genetic predisposition and viral infections (human papillomavirus and herpes simplex virus) have also been reported as causative factors [1,4]. ...
... Blood-derived products have been used in ophthalmology since 1946 [5]. Platelet-rich fibrin (PRF), described by Choukroun et al. in 2001, is a secondgeneration platelet concentrate obtained from centrifugation of an autologous blood sample and from which we obtain a PRF membrane enriched with platelets and their biologically active agents that favors hemostasis, epithelial regeneration and wound healing at the injury site [1,2,5,6]. ...
Pterygium is a common ocular disease caused by abnormal cellular proliferation leading to abnormal fibrovascular growth of the conjunctiva. The main treatment is surgical removal; however, despite the improvement of surgical techniques and development of adjuvant therapies, postoperative recurrence, which can be as high as 89%, remains a challenge. Currently, pterygium excision with conjunctival autograft remains the preferred surgical technique, although there is no gold standard technique to prevent pterygium recurrence. We have conducted a thorough and comprehensive review of the scientific literature regarding the use of PRF membranes in pterygium surgery. We aim to assess the safety, effectiveness, and applicability of platelet-rich fibrin membrane for primary pterygium surgery and assess its possible benefits in resource-limited settings.
