Journal of Clinical Medicine · 7 authors, 4 centres
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This retrospective longitudinal study compared standard dry eye treatment to standard treatment plus plasma rich in growth factors (PRGF) in 83 patients, finding that PRGF significantly improved corneal nerve density, length, and branching, and tear film stability. The main limitation is the retrospective design and the lack of monitoring for eyelid/Meibomian gland dysfunction, which may explain why improvements were more pronounced in aqueous deficient dry eye.
Dry eye disease (DED) is associated with corneal nerve damage. In vivo corneal confocal microscopy (IVCM) can quantify these changes. The study aimed to analyze corneal innervation recovery in DED patients treated with standard therapy versus standard therapy plus plasma rich in growth factors (PRGF). Methods: This was a retrospective, longitudinal, observational study of 83 patients with DED (OSDI >13, break up time <10 s). Patients were grouped into standard treatment (n=32) or standard treatment plus PRGF (n=51). Tear film stability, tear production, and symptom scores were also assessed. Patients were subdivided into evaporative (EDE) and aqueous deficient (ADDE) dry eye. Key Results: In the overall sample, PRGF treatment significantly increased corneal nerve fiber density (CNFD), nerve fiber length (CNFL), branch density (CNBD), and fractal dimension (CNFrD) (p<0.005 for all). Tear film break up time also significantly improved (p=0.003). In the ADDE subtype, PRGF treatment led to significant increases in CNFD, CNFL, and CNBD (p<0.05). In the EDE subtype, nerve parameter changes were not statistically significant for either treatment. Both groups showed significant reductions in symptom scores (OSDI, SANDE). Limitations: The study is retrospective and observational, with a relatively small sample size. Eyelid/Meibomian gland dysfunction was not monitored, which may explain the differential response between DED subtypes. All patients had an evaporative component (BUT <10 s). Implications: PRGF combined with standard treatment appears to promote corneal nerve regeneration, particularly in aqueous deficient DED. IVCM is a useful tool for monitoring this process. Future prospective studies with larger samples and monitoring of eyelid function are needed.
