Exploring Innovative Treatments in Glaucoma: The Role of Cord Blood Serum, Platelet-Rich Plasma, and Autologous Serum Drops: always check with your eyeMD or eyeOD Before using any non-FDA approved drop particularly if you have glaucoma or have had glaucoma surgery (ie. a tube or bleb):
Understanding Glaucoma: The Physiological Pathway
Glaucoma is a group of eye conditions that damage the optic nerve, which is vital for good vision. This damage is often associated with an increase in intraocular pressure (IOP). Here’s how glaucoma typically progresses:
1. Aqueous Humor Production and Drainage: The eye produces a fluid called aqueous humor which maintains the eye's shape and nourishes intraocular structures. Normally, this fluid is drained through the trabecular meshwork at the angle where the iris meets the cornea.
2. Drainage Obstruction: In glaucoma, the drainage of aqueous humor can become blocked or less efficient. This might occur due to genetic factors, aging, or other secondary causes, leading to an accumulation of fluid.
3. Increased Intraocular Pressure: The blocked drainage results in increased pressure within the eye. This pressure can compress and damage the optic nerve fibers, leading to vision loss.
4. Optic Nerve Damage: The optic nerve, responsible for transmitting visual information from the eye to the brain, begins to degenerate. This damage initially affects peripheral vision but can eventually lead to central vision loss if not managed.
5. Visual Field Loss: Over time, as nerve fibers die, blind spots develop in the visual field, progressively narrowing the field of vision.
Innovative Treatments: Cord Blood Serum, Platelet-Rich Plasma (PRP), and Autologous Serum Drops
### Cord Blood Serum (CBS)
- Physiological Mechanism:
- Trophic Support: CBS contains growth factors and other trophic agents beneficial for ocular surface repair. These elements can support epithelial cell proliferation and migration, crucial for healing after glaucoma surgery where the ocular surface might be compromised.
- Anti-inflammatory Effects: CBS can reduce inflammation, which is beneficial for patients undergoing glaucoma surgeries that might induce inflammatory responses.
- References:
- Topical Treatment with Cord Blood Serum in Glaucoma Patients: A Preliminary Report - [PubMed](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4813618/), published April 2016.
### Platelet-Rich Plasma (PRP) Drops
- Physiological Mechanism:
- Growth Factor Cocktail: PRP is rich in growth factors like PDGF, EGF, and TGF-β, promoting cell proliferation, migration, and tissue repair. For glaucoma patients, particularly those with secondary ocular surface disease (OSD), these drops can enhance healing, reduce inflammation, and potentially decrease IOP through modulation of TGF-β activity.
- Anti-Fibrotic Effects: By balancing the PDGF/TGF-β ratio, PRP can reduce scar tissue formation, which is crucial post-glaucoma surgery to maintain bleb function.
- Neuroprotective Properties: The presence of nerve growth factor in PRP might offer neuroprotection or aid in nerve regeneration, potentially mitigating some of the neurodegenerative aspects of glaucoma.
- References:
- Plasma Rich in Growth Factors for the Treatment of Ocular Surface Diseases - [PubMed](https://pubmed.ncbi.nlm.nih.gov/28179483/), published February 2017.
- Plasma rich in growth factors eye drops to treat secondary ocular surface disorders in patients with glaucoma - [PubMed](https://pubmed.ncbi.nlm.nih.gov/30443584/), published November 2018.
- The role of "eye platelet rich plasma" (E-PRP) for wound healing in ophthalmology - [PubMed](https://pubmed.ncbi.nlm.nih.gov/21740369/), published June 2012.
- Autologous platelet-rich plasma eye drops for the treatment of post-LASIK chronic ocular surface syndrome - [PubMed](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695789/), published November 2017.
### Autologous Serum Drops (ASD)
- Physiological Mechanism:
- Nutritional Support: Similar to PRP, ASD contains a mix of growth factors and nutrients that mimic the natural tear film, aiding in the healing of the ocular surface in glaucoma patients, especially those with dry eye syndrome post-surgery.
- Anti-inflammatory: By providing a natural environment for the ocular surface, ASD can help manage inflammation, which is often exacerbated in glaucoma due to medications or surgery.
- References:
- Autologous Serum Eye Drops in the Management of Limbal Stem Cell Deficiency Associated with Glaucoma Surgery - [PubMed](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8221663/), published June 2021.
- Autologous serum-based eye drops for treatment of ocular surface disease - [American Academy of Ophthalmology](https://www.aaojournal.org/article/S0161-6420(20)31120-0/fulltext), published September 2020.
Clinical Insights from Recent Studies
Results reported herein support that in glaucoma patients with secondary OSDs, treatment with PRGF eye drops could be considered a possible therapeutic option to improve associated signs and symptoms and to reduce IOP. There are several potential explanations for these effects:
- Growth Factor Richness: PRGF (Plasma Rich in Growth Factors, essentially PRP) contains a cocktail of trophic agents, including significant amounts of EGF, promoting accelerated healing of corneal injuries.
- Anti-Fibrotic Balance: The balance of PDGF/transforming growth factor-β1 (TGF-β1) in PRGF helps reduce scar formation, which is beneficial for maintaining surgical outcomes in glaucoma.
- Anti-Inflammatory Properties: By reducing inflammation, PRGF could enhance patient compliance with glaucoma treatments, particularly topical medications.
- Neurotrophic Support: The inclusion of NGF in PRGF might support the health of corneal nerves, which could indirectly benefit the optic nerve.
- Modulation of TGF-β: PRGF's ability to modulate TGF-β activity can decrease fibrosis, enhance cell regeneration, and potentially lower IOP by improving aqueous humor outflow.
Conclusion
The use of CBS, PRP, and ASD in glaucoma management, especially in patients with compromised ocular surfaces or post-surgical complications, offers promising avenues for improving outcomes. These treatments leverage the natural healing properties of blood derivatives, aiming to reduce inflammation, promote healing, and possibly manage IOP through novel mechanisms. While these therapies are not yet standard of care, ongoing research and clinical trials continue to explore their full potential in glaucoma therapy. As we gain more insights, these could become integral parts of managing this complex eye condition.
Glaucoma and Cord Blood Serum:
1. This is the only case report (2 patients) on the use of CBS with glaucoma. This was published 2018 and has not been replicated. There are always issues with case reports but having used CBS drops on patients, it appears CBS is safe. Efficacy for treating glaucoma as a neuroprotective agent remains to be replicated but is promising.
Abstract
Purpose
To report data which happened to be observed in two glaucoma patients treated with Cord Blood Serum (CBS) eye drops.
Design
A case report and retrospective data analysis.
Methods
CBS topical eye drops, characterized in advance for growth factors (GFs) content, were administered for two months with the aim to relieve their subjective symptoms, in two patients who had referred ocular surface discomfort, although in absence of any sign of keratopathy. As patients were also affected by advanced glaucoma at risk of vision loss and under treatment with hypotensive drugs, they had been also monitored over the same period with IOP controls and visual field tests in our unit.
Results
During subsequent visits, data from Mean Deviation and Pattern Standard Deviation in the visual fields were retrospectively collected and compared with before and after treatment with CBS, and an amelioration was observed.
Conclusions
CBS contains a combination of GFs, which potentially exert a neuroprotective action and elect CBS as an interesting natural source to be delivered in neurodegenerative ocular disorders. The incidentally observed amelioration in these two patients deserves further investigation in this respect.
Abstract
Regenerative medicine is a branch of medicine that incorporates tissue-engineering, biomaterials, and cell therapy approaches to replace or repair damaged cells and tissues. Umbilical cord serum (UCS) is an important liquid component of cord blood, which has a reliable source of innumerable growth factors and biologically active molecules. Usually, serum can be prepared from different sources of blood. In therapeutic application, cord serum can be prepared and used in the form of eye drops for the treatment of severe dry eye diseases, ocular burns, glaucoma, persistent corneal epithelial defects and neurotrophic keratitis. In addition, cord serum combined with synthetic bio scaffold materials is used to regenerate different types of tissues including tympanic membrane regeneration, bone regeneration and nerve regeneration. Absence of animal origin viruses and bacteria, lack of xenoproteins and cost-effective features make cord serum a feasible choice as replacement of fetal bovine serum in cell culture techniques. Thus, this review emphasizes the role of cord serum in regenerative therapy and clinical uses.
Plasma rich in growth factors eye drops to treat secondary ocular surface disorders in patients with glaucoma
- PMID: 29760570
- PMCID: PMC5937507
- DOI: 10.2147/IMCRJ.S153918
Abstract
Purpose: To evaluate the efficacy and safety of plasma rich in growth factors (PRGF) eye drops in patients with glaucoma with secondary ocular surface disorders (OSDs) due to surgeries and topical hypotensive drugs use.
Materials and methods: A retrospective case-series study design was used including six patients (eight eyes) diagnosed with glaucoma who received surgical (nonpenetrating deep sclerectomy and/or trabeculectomy) and medical treatments (hypotensive eye drops) to control intraocular pressure (IOP) and who developed secondary OSDs, unresponsive to conventional treatments. Patients were treated with PRGF eye drops (four times a day). Outcome measures were ocular surface disease index (OSDI), best-corrected visual acuity (BCVA, in logarithm of the minimum angle of resolution), visual analog scale (VAS), frequency and severity of symptoms, and IOP. The safety of the treatment was also evaluated.
Results: Six patients (seven eyes with open-angle glaucoma and one eye with uveitic glaucoma) treated with PRGF eye drops were evaluated. Mean age was 71 years (SD=7.2, range 58-79 years). Five were female and one was male. The mean treatment time was 21.8 weeks (SD=9.0, range 12-36 weeks). The mean time to reach closure of the corneal ulcer was 14.5 (SD=5.5) weeks. A statistical significant reduction in OSDI scale (50.6%), VAS frequency (53.1%), VAS severity (42.0%), and a 41.8% improvement in BCVA were observed (p<0.05). IOP also decreased by 16.6% (p=0.010). Only one of the six patients reported itching in both eyes as an adverse event (AE); however, the patient continued with the PRGF eye drops until the end of therapy; the remaining patients did not report any AEs during the follow-up period.
Conclusions: In patients with glaucoma and secondary OSDs refractive to conventional treatments, the treatment with PRGF eye drops could be considered a possible therapeutic option, because it demonstrates an improvement in the signs and symptoms of the ocular surface, as well as a better control of the IOP. This is an initial research work that can open doors for future research to confirm these findings.
Keywords: PRGF; PRP; glaucoma; ocular surface disorders; plasma rich in growth factors; platelet-rich plasma.
Topical Treatment with Cord Blood Serum in Glaucoma Patients: A Preliminary Report
- PMID: 30147975
- PMCID: PMC6083596
- DOI: 10.1155/2018/2381296
Abstract
Purpose: To report data which happened to be observed in two glaucoma patients treated with Cord Blood Serum (CBS) eye drops.
Design: A case report and retrospective data analysis.
Methods: CBS topical eye drops, characterized in advance for growth factors (GFs) content, were administered for two months with the aim to relieve their subjective symptoms, in two patients who had referred ocular surface discomfort, although in absence of any sign of keratopathy. As patients were also affected by advanced glaucoma at risk of vision loss and under treatment with hypotensive drugs, they had been also monitored over the same period with IOP controls and visual field tests in our unit.
Results: During subsequent visits, data from Mean Deviation and Pattern Standard Deviation in the visual fields were retrospectively collected and compared with before and after treatment with CBS, and an amelioration was observed.
Conclusions: CBS contains a combination of GFs, which potentially exert a neuroprotective action and elect CBS as an interesting natural source to be delivered in neurodegenerative ocular disorders. The incidentally observed amelioration in these two patients deserves further investigation in this respect.
Regenerative Therapy Using Umbilical Cord Serum
- PMID: 33622862
- PMCID: PMC8045055
- DOI: 10.21873/invivo.12310
Abstract
Regenerative medicine is a branch of medicine that incorporates tissue-engineering, biomaterials, and cell therapy approaches to replace or repair damaged cells and tissues. Umbilical cord serum (UCS) is an important liquid component of cord blood, which has a reliable source of innumerable growth factors and biologically active molecules. Usually, serum can be prepared from different sources of blood. In therapeutic application, cord serum can be prepared and used in the form of eye drops for the treatment of severe dry eye diseases, ocular burns, glaucoma, persistent corneal epithelial defects and neurotrophic keratitis. In addition, cord serum combined with synthetic bio scaffold materials is used to regenerate different types of tissues including tympanic membrane regeneration, bone regeneration and nerve regeneration. Absence of animal origin viruses and bacteria, lack of xenoproteins and cost-effective features make cord serum a feasible choice as replacement of fetal bovine serum in cell culture techniques. Thus, this review emphasizes the role of cord serum in regenerative therapy and clinical uses.
Keywords: Umbilical cord serum; cytokines; growth factors; regeneration; review.
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