The authors have no financial interest in the subject matter of this poster Mohit Jain MD, Anita Panda MD, Murugesan Vanathi MD, Sudarshan Khokhar MD, Tanuj Dada MD Topical Application of Autologous Platelet-Rich Plasma for Acute Ocular Chemical Burn Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences, New Delhi, India

Introduction Biological agents like autologous serum, umbilical cord serum have been used for restoration of ocular surface and control of inflammatory process owing to presence of significant concentrations of growth factors 1,2 Autologus PRP contain 5 t0 6 times higher concentration of growth factors 3 which are constantly released from α granules present in platelets Before activation After activation Platelets remain viable for 3-4 days Has a lubricating property Starts coagulation process and provides fibrin scaffold Contains 3- 4 times more platelets Topical PRP is used in ocular surface disorder following LASIK, dry eye and dormant corneal ulcers 1,2,3,4,5 Clinically used among musculoskeletal physicians, orthopedic surgeons, maxillofacial and plastic surgeons and dermatologists

Aim of the study Comparative evaluation of topical autologous PRP given along with standard medical treatment with standard medical treatment alone in acute ocular chemical burns Materials and methods Randomized prospective comparative double blind case control study The study population was recruited from a university-based cornea clinic and ophthalmology emergency department Institutional Ethical Committee approval was sought and written informed consent was taken from participants Inclusion criteria: Patients with grade III, IV & V ocular chemical injury Patients presenting within 3 days of injury Exclusion criteria: Patients with impending perforation /perforated cornea

Materials and Methods 20 eyes were randomly assigned Group 1 (10 eyes) – Received Autologous PRP with standard medical treatment 6 Group 2 (10 eyes) – Received standard medical treatment All participants underwent comprehensive history taking and ophthalmologic examination, including best corrected visual acuity (BCVA), cornea clarity grading, size and area of epithelial defect(product of two maximum linear dimensions perpendicular to each other), extent of limbal ischemia, grading of chemical injury according to Dua classification 7, clinical photograph (CP) with and without fluorescein stain, tear film status evaluation, intraocular pressure (IOP) Autologous PRP was prepared under aseptic precautions and stored at 4°C 5 Follow up was done on day 3, 7, 14, 21 and month 1, 2 and 3 Chi square test for categorical variables and Mann-Whitney tests far quantitative variables were applied for statistical analysis

Table 1: Demographic data of Participants Group 1 (Mean) Group 2 (Mean) P-VALUE AGE(years)* DURATION BETWEEM EXPOSURE AND RPC TREATMENT (days)* CORNEA CLARITY# LARGEST EPITHELIAL DEFECT DIMENSION(mm) # EPITHELIAL DEFECT AREA(mm 2 ) # LIMBAL ISCHEMIA(clock hours)# BCVA(log MAR)# * Independent t test # Wilcoxon rank-sum (Mann-Whitney) test Graph 1 Nature of chemical No. of participants

D0D3D7D14D21M1M2M3 Group 1* 7.65±2.29, 7.7(4.5-11) 4.80±2.82, 3.35(1.8-10) 2.69±3.15, 1.4( ) 1.16±1.31, 0.65(0-3.30) 0.53±0.72, 0(0-1.8) 0.34±0.53,0 (0-1.4) 0.08±0.17,0( 0-0.5) 0.0±0.0 Group 2* 6.44±3.58, 6.25( ) 5.25±3.39, 4.15( ) 5.06±3.64, 3.65(2.5-11) 3.98±3.69, 2.8(0-10.7) 2.98±4.02, 1.5(0-10.8) 1.85±3.53,0 (0-9.8) 0.90±1.91,0 (0- 0.5) 0.0±0.0 P value Table 2: Mean epithelial defect diameter (EDD) resolution *EDD - Mean±SD, median(range) (mm) Mean EDD (mm) Time → %age decrease in EDD Time → Graph 2: Mean EDD Graph 3: % decrease in EDD

D0D3D7D14D21M1M2M3 Group 1* 54.31±33.21, 51.97( ) 25.79±31.74,8.04( ) 13.79±24.83,7( ) 1.69±2.67, 0.21(0-6.93) 0.28±0.41, 0(0-1`.26) 0.09±0.16, 0(0-0.42) 0.21±0.4,0( ) 0-0(0-0) Group 2* 42.06±44.53, 25.55( ) 32.63±39.31,13.52( ) 35.53± ( ) 23.79±39.43,5. 6( ) 20.82±41.2 3,1.43( ) 13.05±29. 04,0( ) 0.08±170 (0-0.50) 0-0(0-0) P value Table 3: Mean epithelial defect area (EDA) progression Mean EDA mm 2 Time → The mean time to complete epithelialisation was 40±31.57,25.5 (7 to 90)days and 47 ±26.15,30.0( 21 to 90) days, in group 1 and group 2 respectively. The difference was not statistically significant. (p=0.29) For grade 3 injuries mean time to complete epithelialisation was significantly less 14 ± 7,14(7 to 21)days in group 1 compared to and 28.5 ±3.67,28.5(21 to 30)days in group 2. p value(0.006) EDA - Mean±SD, median(range) (mm 2 ) Graph 4: Mean EDA

Cornea clarity Group 1Group 2Total Total10 20 Cornea clarity Group 1Group 2Total Table 4: Cornea clarity at presentationTable 5: Cornea clarity at 3 months p value 0.048p value At 3 months, 5 out of 10(50 %) patients had corneal clarity of grade 4 in group 1 as compared to 2 out of 10 (20 %) in group 2. The difference was statistically significant. (p- value 0.04)

Table 7: Complications Complications Group 1 Group 2 P value* Increased intraocular pressure340.9 Infiltrate111 perforation000 symblepheron Entropion and ectropion221 * Fisher exact test visual acuity at presentation Visual acuity at 3 rd month Percentage improvement in visual acuity PRP Mean±SD median,range 1.06 ±18,1.0( ) 0.66 ±.60,40( ) ± 55.75,55.49(- 80 to 100) Std tt Mean±SD median,range 1.09 ± 20,1.0( ) 0.93 ± 0.35,0.85( ) p [Mean±SD, median (range)] BCVA at presentationBCVA at 3 months% improvement in BCVA Group ±18,1.0( )0.66 ±.60,40( )33.64 ± 55.75,55.49(-80 to 100) Group ± 20,1.0( )0.93 ± 0.35,0.85( )37.74 ± 9.66,36.70(-20 to 50) p Table 6: BCVA

MONTH 1 DAY 14 DAY 7 GROUP 2GROUP 1 MONTH 2 and 3 DAY 0

Addition of topical autologous PRP to standard treatment protocol helps in rapid re-epithelialisation of ocular surface and achieve better corneal clarity There is a trend towards achieving better BCVA with addition of topical autologous PRP at 3 months (though not statistically significant) We recommend use of topical autologous PRP therapy along with standard medical treatment in cases of ocular chemical injuries of grade3, grade4 and grade5 Studies with larger sample size and longer follow up periods are required Conclusions

References 1. Poon AC et al. Autologous serum eyedrops for dry eyes and epithelial defects: clinical and in vitro toxicity studies. Br J Ophthalmol Oct; 85(10): Singh G et al. Epidermal growth factor in alkali burned corneal epithelial wound healing. Am J Ophthalmol June; 103(6): Alio JL et al. A Symptomatic dry eye treatment with autologous platelet-rich plasma. Ophthalmic Res Mar; 39(3): Alio JL et al. Use of autologous platelet-rich plasma in the treatment of dormant corneal ulcers. Ophthalmology Jul; 114(7): Alio JL et al. Treatment of ocular surface syndrome after LASIK with autologous platelet- rich plasma. J Refract Surg Jun; 23(6): Brodovsky SC et al. Management of alkali burns: 11 year retrospective review. Ophthalmology Oct; 107(10): Dua HS et al. A new classification of ocular surface burns. Br J Ophthalmol Nov; 85(11): Acknowledgements Dr. T. Velpandian Associate Professor, Dept. of Ocular Pharmacology,AIIMS Mr. Pankaj Gupta Dept. of Ocular Pharmacology,AIIMS Dr. Manik Goel, MD Dr. Amit Sobti, MD Dr.Twinkle Parmar, MD