Injectable platelet-rich fibrin for corneal epithelium healing: An in vivo confocal microscopy study after crosslinking

Abstract

| Purpose: This study was conducted to investigate the effect of injectable platelet-rich fibrin on the recovery of compromised epithelium due to crosslinking treatment. Methods: In this comparative study, the epithelial closure rates and in vivo confocal biomicroscopy results of 26 patients with keratoconus who underwent subconjunctival injection of injectable platelet-rich fibrin near the limbus after epithelium-off corneal crosslinking treatment were compared with those of 25 patients who did not receive the injection of injectable platelet-rich fibrin. Results: The average time to epithelial defect closure in the injectable platelet-rich fibrin group was 2.76 +/- 0.90 days compared to 3.56 +/- 0.86 days in the non-injectable platelet-rich fibrin group (p=0.003). At the end of the 1st month, the mean subbasal nerve plexus density was 1.26 +/- 1.61 nerves/mm2 in the injectable platelet-rich fibrin group, whereas it was 0.72 +/- 0.89 nerves/mm2 in the non-injectable platelet-rich fibrin group (p=0.016). By the 3rd month, the density increased to 3.42 +/- 1.13 nerves/mm2 in the injectable platelet-rich fibrin group and 2.36 +/- 1.15 nerves/mm2 in the non-injectable platelet-rich fibrin group (p=0.002). Similarly, the anterior stromal keratocyte density at the end of the 1st month was 93.6 +/- 33.5 cells/mm2 in the injectable platelet-rich fibrin group compared to 67.3 +/- 26.4 cells/mm2 in the non-injectable platelet-rich fibrin group (p=0.001). By the end of the 3rd month, the density increased to 255.2 +/- 45.7 cells/mm2 in the injectable platelet-rich fibrin group and 222.1 +/- 43.6 cells/mm2 in the non-injectable platelet-rich fibrin group (p=0.011). In the non-injectable platelet-rich fibrin group, one patient developed a sterile infiltrate at the end of the 1st week, whereas no complications were observed in the injectable platelet-rich fibrin group. Conclusion: Subconjunctival injectable platelet-rich fibrin application is an effective and safe method for corneal epithelial healing after crosslinking treatment.