Progress in the use of plasma rich in growth factors in ophthalmology: from ocular surface to ocular fundus

ABSTRACT

Introduction

The use of blood derivatives and especially Plasma rich in growth factors (PRGF), for regenerative purposes has been a common trend along the last decades in the field of oral surgery, dermatology, orthopedics, and more recently in ophthalmology.

Areas covered

PRGF is a type of platelet-rich plasma that is being explored for the treatment of ocular injuries. The present review article highlights 50 ophthalmology-related publications about the application of PRGF in the treatment of acute and chronic pathologies in ophthalmology as well as most relevant challenges and future prospects.

Expert opinion

PRGF technology provides a wide range of formulations that can be used therapeutically in many different acute and chronic ocular pathologies. In addition to eye drops enriched with autologous growth factors, PRGF enables the preparation of both immunologically safe and fibrin-based formulations. Recent advances in the field have promoted PRGF storage for 12 months under freezing conditions, its daily use for 7 days at room temperature and the freeze-dried formulation. The thermally treated immunosafe formulation has shown promising clinical results for the treatment of several diseases such as Sjögren syndrome, graft versus host disease or cicatrizing conjunctivitis. In addition, several fibrin formulations have been preclinically evaluated and clinically incorporated as an adjuvant to ocular surface or glaucoma surgeries, dermal fat graft procedures, limbal stem cell expansion and retinal surgeries. The present review explores the latest scientific and clinical data, current challenges, and main prospects of this technology for the treatment of several ocular injuries.

KEYWORDS:

• PRGF
• platelet-rich plasma
• growth factors
• immunosafe
• freeze-dried
• regenerative medicine
• Sjögren Syndrome
• graft versus host disease
• Cicatrizing conjunctivitis
• glaucoma
• macular hole

Article highlights

• The improvement in the quality of life and life expectancy of the human population during the last decades has favored the ageing of the world population. As a result, the prevalence of age-related diseases has increased, prompting the development of novel regenerative treatments and less invasive procedures.

• Along the last decades, the ever-increasing knowledge of tissue regeneration has encouraged researchers from diverse disciplines to develop new biocompatible materials and technologies to improve and accelerate wound healing in a wide range of pathologies in different medical areas.

• Ophthalmology is a medical area undergoing a remarkable progress in terms of the use of several customized regenerative therapies.

• Human blood derivatives such as autologous serum have shown their potential due to their regenerative properties. However, when platelets were described as the principal actor in the regenerative tissue performance, a broad range of platelet-rich plasma (PRP) products were developed to stimulate tissue regeneration.

• However, there are many PRP protocols described so far as well as mixed results, limiting the understanding of their healing activity and their clinical potential.

• PRGF is a type of platelet-rich plasma characterized by the lack of leukocytes, a controlled platelet-fibrinogen activation step, versatile formulations and a long-term biostability.

• Although future clinical trials would be desirable, current evidence suggests that PRGF-based formulations show preliminary efficacy for the treatment of many different acute and chronic ocular pathologies.

This box summarizes key points contained in the article.

Acronyms

PRGF plasma rich in growth factors; mPRGF membrane; cPRGF clot; ePRGF supernatant/eye drops; is-ePRGF immunosafe supernatant/eye drops; is-mPRGF immunosafe membrane; HCF conjunctival fibroblasts; HK keratocytes

Acknowledgments

The authors thank Drs Montero and Suarez-Figueroa for sharing images for the elaboration of diagrams.

Declaration of interest

E Anitua is a Scientific Director of BTI Biotechnology Institute, a dental company that investigates the fields of implantology and PRGF-Endoret technology. F Muruzabal, B de la Sen, P Heredia, R Sánchez and G Orive are also scientists at BTI Biotechnology Institute. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This study is funded by the BIOGARDENA project (nº ZL-2020/00561), funded by the HAZITEK program of the Department of Economic Development and Infrastructure of the Basque Country Government.