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Bovine pericardium membrane, platelet-rich plasma clot resolve perforated corneal ulcers
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A bovine pericardium patch combined with autologous platelet-rich plasma was effective in closing perforated corneal ulcers, according to a study.
The authors explored the use of a collagenous patch derived from bovine pericardium (Tutopatch, Tutogen Medical) combined with a clot of autologous eye platelet-rich plasma (E-PRP) as a viable alternative to amniotic membrane or donor corneal tissue grafting.
“Considering the autologous nature of the E-PRP clot and the easy access of Tutopatch and its low biological risk, this technique can be proposed as an accessible and biologically active solution for the urgent management of perforated corneal ulcers,” Jorge L. Alió, MD, PhD, an OSN Europe Edition Board Member and the corresponding author, said in an email interview.
Autologous corneal tissue grafting is not always a viable option because suitable donor tissue is frequently unavailable. Amniotic membrane grafting poses potential risks, such as viral contamination and poor biocompatibility, the authors said. The prospective study was published in Cornea.
Patients and procedures
The study included six patients with perforated corneal ulcers secondary to severe corneal ulcerative disease. Perforations ranged from 0.5 mm to 1.5 mm.
Patients underwent prophylactic treatment with topical second-generation quinolones at the time of diagnosis; no eyes showed signs of active infection at the time of surgery.
All patients received a bovine pericardium patch and combined E-PRP clot.
The bovine pericardium patch was placed under retrobulbar anesthesia. The patch was trimmed to a circular shape with a diameter of about 14 mm; 10-0 nylon sutures were used to affix the patch to the inferior conjunctiva.
The E-PRP clot was placed onto the corneal surface under the patch. A partial temporal tarsorrhaphy was performed in all cases.
Patients were observed daily for 10 days. Infection and signs of inflammation were evaluated; gentle finger pressure on the globe was used to assess ocular pressure.
The temporal tarsorrhaphy was opened 2 to 3 weeks after surgery. All cases were followed up for at least 3 months before subsequent corneal surgery was performed.
Results and conclusions
The corneal perforation was sealed in all cases. The bovine pericardium patch was present over the corneal surface until the tarsorrhaphy was opened. No signs of infection or inflammation were reported. No patients reported pain, discomfort or any other subjective symptoms.
Ocular pressure was deemed acceptable 2 days after surgery.
The pericardium patch used in conjunction with an E-PRP clot may enable faster healing than amniotic membrane alone, but there is insufficient evidence, Alió said.
“The combined use of Tutopatch with E-PRP clot most likely allows faster healing than with amniotic membrane alone, but we have not done comparative studies because we stopped using amniotic membrane a long time ago,” he said.
Pericardium membrane is biologically inert and compatible with corneal tissue, while amniotic membrane requires strict serologic analysis before use, Alió said. – by Matt Hasson