Tuesday, September 12, 2017

Injection of Platelet Rich Plasma into the Meibomian Gland Seems to Improve Meibomian Gland Structure and Potentially Function: Case of 1. This Bodes Well for the Injection of Stem Cells into the Meibomian Gland

Below are the chronological photos (meibographies) of our first case of PRP injection into the Meibomian Glands (3 injected).

As you can see below, many central glands were absent prior to PRP injection. After PRP injection the glands seem to have grow back.

The question remains: was this from just the probing and expression or did the PRP injection really make the difference. I believe it was the PRP injection as she had probing done before in this eyelid without much improvement.







Here are more details:
Notice the dates below:

BEFORE PRP INJECTION: RIGHT LOWER LID



ABOVE: This is how her meibomian gland in her right eyelid looked before PRP injection but after probing and expression. 
BEFORE PRP INJECTION: RIGHT LOWER LID



BELOW: 
AFTER PROBING, EXPRESSION, PRP INJECTION: PRP ONLY INJECTED INTO RIGHT LOWER LID INTO MISSING GLAND AREA;




Below I was able to put the near-infrared (NIR) illumination of the PRE-PRP and POST-PRP side by side so you can see the difference.

On the left is the original Meibography. You can see the black spot on the bottom scan which we think represents scarred, "never to come back" glands. 

On the right, at the bottom, you can see that the black area is "filling in" as if the glands are coming back and working to produce oil. 





And now look at today's Meibography of the right lower lid below: 9/12/2017. The gland has grown back fully. This is very exciting!


THIS IS AFTER PRP INJECTION: 
This patient has early Sjogren's Syndrome so time will determine if this improved gland function will relieve all her pain. She is very young and came in with 10/10 eye pain on a daily basis. She used to spend 8-9 hours on the computer and did not know she had markers on her Sjogren's panel when she first came in. Now she is being treated with Plaquenil and her pain scored have improved to a 6-7/10. She recently ate "a lot of gluten" in the form of pizza and bread and she says her pain went up to a 7-8/10.  I have heard this from many patients but I have not seen it published that gluten can make the dry eye symptoms worse so dramatically. Still I do recommend a gluten free diet for dry eye patients.

The results of the PRP injection look promising. More studies are needed. Currently we are about to sign up for a Stem Cell Research Protocol as I know I can get the stem cells into the meibomian glands with our current protocol. While all these protocols are experimental, the alternative of continued loss and scarring of the glands is devastating. I recently saw a 21 year old woman with no glands in any lids. I will post that shortly. She is desperate as she has pain more than 18 hrs per day: the eye pain wakes her up from sleep. Her options are few. There are no guarantees even with PRP or Stem Cell injections, which makes this a frustrating disease for everyone involved! 

Still I have hope. This patient has noticed some improvement in her symptoms with just one PRP injection. I pray future research will prove PRP and Stem Cell Injections into the Meibomian Glands to be a ground breaking treatment for Dry Eye Disease. 

Sandra Lora Cremers, MD, FACS


Again:
------
BEFORE PRP Injection:



See this big empty area in the center of the lid? These were the glands that were injected with the patient's own PRP.

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AFTER PRP INJECTION:






Look at just the lower lid as that is the one whose central missing glands were injected.


15 comments:

  1. This sounds so promising for all of the patients who have MG atrophy. Is it possible the ducts were not atrophied but only no longer patent and that PRP restores patency?

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    Replies
    1. Great question. We are not sure but hope to follow these patients to see if we can revive these glands and "grow them back."

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  2. Awesome!!! thx very much. you are the sunrise in the darkness.

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  3. did you see: Restoration of Human Lacrimal Function Following Platelet-Rich Plasma Injection
    https://insights.ovid.com/pubmed?pmid=24240491

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  4. Yes. We have started a PRP injection into the Lacrimal gland protocol: posting on blog soon.

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    Replies
    1. Please let me know. I will be your volunteer. I am so desperate with my dry eye.

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  5. This is such a useful blog with nice information and images. This is giving excellent knowledge to the viewers. Thank you so much friend to share post like this.

    Platelet Enriched Plasma Therapy

    ReplyDelete
    Replies
    1. Thank you, Ricki! Let others know that there is hope.

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    2. Hi can you please reply to my bottom comment when you get a chance many thanks :)

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  6. Hi is there a risk that the glands can be scarred form getting these prp injections ? And will only dead glands be injected? Like the healthy ones would be touched?

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  7. And one more thing I know this may sound silly.. but with the gland growing back does that mean there will def be oil producing within that gland??

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  8. Wow - I’ve suffered with MG Dysfunction / Atrophy for 5 years. Ive been looking for a dr to do a lethal injection as there’s no point in living as I can’t work, I Can’t do anything and there’s no point to live with no purpose. I’ll give it one more chance and look for an eye doc who does PRP in or near El Dorado Hills, CA.

    ReplyDelete

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