Autologous platelet-rich plasma eyedrops for severe dry eye disease unresponsive to autologous serum: A prospective single-arm interventional study.

BACKGROUND: Some patients with dry eye disease (DED) respond sub-optimally to autologous serum (AS) therapy. Platelet-rich plasma (PRP), a blood-derived preparation with higher platelet-derived growth factor concentrations, may benefit patients refractory to AS. OBJECTIVES: To evaluate the short-term efficacy and safety of topical autologous PRP eyedrops in patients with severe DED unresponsive to AS. DESIGN: Prospective single-arm interventional study with AS re-challenge. METHODS: Twenty eyes (10 patients) with severe DED unresponsive to 100% AS were enrolled. Participants applied 100% autologous PRP eyedrops six times daily for 6 weeks, then 100% AS eyedrops for 6 weeks. Ocular Surface Disease Index (OSDI) scores, conjunctival and corneal staining (NEI scores), tear film break-up time (TBUT), Schirmer test were evaluated at baseline, weeks 1, 4, 6, and 12. Subbasal nerve and dendritic cell density were assessed by in vivo confocal microscopy (IVCM) in the worse eye at baseline, week 6 and 12. Data were analyzed using a mixed-effects model with patient identity as a random effect and Bonferroni correction. RESULTS: OSDI scores improved significantly at weeks 1, 4, and 6 (adjusted P = 0.04, <0.01, <0.01). Conjunctival staining improved at weeks 4 and 6, corneal staining at week 1, and TBUT at weeks 1 and 6 (all P <0.05). After transitioning to AS, no statistically significant differences from baseline were observed for any parameter at week 12. Schirmer test, subbasal nerve density, and dendritic cell density showed no significant changes throughout. No adverse events were reported. CONCLUSIONS: Autologous PRP eyedrops were associated with short-term improvements in symptoms and selected ocular surface signs in AS-refractory severe DED, which were not sustained after switching to AS.