The authors have no financial interest in the subject matter of this poster

1. Topical Application of Autologous Platelet-Rich Plasma for Acute Ocular Chemical Burn Mohit Jain MD, Anita Panda MD, Murugesan Vanathi MD, Sudarshan Khokhar MD, Tanuj Dada MD Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences, New Delhi, India The authors have no financial interest in the subject matter of this poster

2. Introduction • Biological agents like autologous serum, umbilical cord serum have been used for restoration of ocular surface and control of inflammatory process owing to presence of significant concentrations of growth factors 1,2 • Autologus PRP contain 5 t0 6 times higher concentration of growth factors 3 which are constantly released from α granules present in platelets Before activation Topical PRP is used in ocular surface disorder following LASIK, dry eye and dormant corneal ulcers1,2,3,4,5 Contains 3- 4 times more platelets Platelets remain viable for 3-4 days Clinically used among musculoskeletal physicians, orthopedic surgeons, maxillofacial and plastic surgeons and dermatologists After activation Starts coagulation process and provides fibrin scaffold Has a lubricating property

3. Aim of the study Comparative evaluation of topical autologous PRP given along with standard medical treatment with standard medical treatment alone in acute ocular chemical burns Materials and methods • Randomized prospective comparative double blind case control study • The study population was recruited from a university-based cornea clinic and ophthalmology emergency department • Institutional Ethical Committee approval was sought and written informed consent was taken from participants • Inclusion criteria: • Patients with grade III, IV & V ocular chemical injury • Patients presenting within 3 days of injury • Exclusion criteria: • Patients with impending perforation /perforated cornea

4. Materials and Methods • 20 eyes were randomly assigned Group 1 (10 eyes) – Received Autologous PRP with standard medical treatment6 Group 2 (10 eyes) – Received standard medical treatment • All participants underwent comprehensive history taking and ophthalmologic examination, including best corrected visual acuity (BCVA), cornea clarity grading , size and area of epithelial defect(product of two maximum linear dimensions perpendicular to each other), extent of limbal ischemia, grading of chemical injury according to Dua classification7, clinical photograph (CP) with and without fluorescein stain, tear film status evaluation, intraocular pressure (IOP) • Autologous PRP was prepared under aseptic precautions and stored at 4°C5 • Follow up was done on day 3, 7, 14, 21 and month 1, 2 and 3 • Chi square test for categorical variables and Mann-Whitney tests far quantitative variables were applied for statistical analysis

5. Table 1: Demographic data of Participants Graph 1 Nature of chemical * Independent t test # Wilcoxon rank-sum (Mann-Whitney) test No. of participants

6. Table 2: Mean epithelial defect diameter (EDD) resolution *EDD - Mean±SD, median(range) (mm) Graph 2: Mean EDD Graph 3: % decrease in EDD %age decrease in EDD Mean EDD (mm) Time → Time →

7. Table 3: Mean epithelial defect area (EDA) progression EDA - Mean±SD, median(range) (mm2) The mean time to complete epithelialisation was 40±31.57 ,25.5 (7 to 90)days and 47 ±26.15,30.0( 21 to 90) days, in group 1 and group 2 respectively . The difference was not statistically significant. (p=0.29) Graph 4: Mean EDA Mean EDA mm2 For grade 3 injuries mean time to complete epithelialisation was significantly less 14 ± 7 ,14(7 to 21)days in group 1 compared to and 28.5 ±3.67,28.5(21 to 30)days in group 2. p value(0.006) Time →

8. Table 4: Cornea clarity at presentation Table 5: Cornea clarity at 3 months p value 0.625 p value 0.048 At 3 months, 5 out of 10(50 %) patients had corneal clarity of grade 4 in group 1 as compared to 2 out of 10 (20 %) in group 2. The difference was statistically significant. (p- value 0.04)

9. Table 7: Complications Table 6: BCVA [Mean±SD, median (range)] * Fisher exact test

10. GROUP 1 GROUP 2 DAY 0 DAY 7 DAY 14 MONTH 1 MONTH 2 and 3

11. Conclusions • Addition of topical autologous PRP to standard treatment protocol helps in rapid re-epithelialisation of ocular surface and achieve better corneal clarity • There is a trend towards achieving better BCVA with addition of topical autologous PRP at 3 months (though not statistically significant) • We recommend use of topical autologous PRP therapy along with standard medical treatment in cases of ocular chemical injuries of grade3 , grade4 and grade5 • Studies with larger sample size and longer follow up periods are required

12. References 1. Poon AC et al. Autologous serum eyedrops for dry eyes and epithelial defects: clinical and in vitro toxicity studies. Br J Ophthalmol. 2001 Oct; 85(10): 1188-97 2. Singh G et al. Epidermal growth factor in alkali burned corneal epithelial wound healing. Am J Ophthalmol. 1987 June; 103(6): 802-7 3. Alio JL et al. A Symptomatic dry eye treatment with autologous platelet-rich plasma. Ophthalmic Res. 2007 Mar; 39(3): 124-9 4. Alio JL et al. Use of autologous platelet-rich plasma in the treatment of dormant corneal ulcers. Ophthalmology. 2007 Jul; 114(7): 1286-1293 5. Alio JL et al. Treatment of ocular surface syndrome after LASIK with autologous platelet-rich plasma. J Refract Surg. 2007 Jun; 23(6): 617-9 6. Brodovsky SC et al. Management of alkali burns: 11 year retrospective review. Ophthalmology. 2000 Oct; 107(10): 1829-35 7. Dua HS et al. A new classification of ocular surface burns. Br J Ophthalmol. 2001 Nov; 85(11): 1379-83 Acknowledgements Dr. T. Velpandian Associate Professor, Dept. of Ocular Pharmacology,AIIMS Mr. Pankaj Gupta Dept. of Ocular Pharmacology,AIIMS Dr. ManikGoel, MD Dr. AmitSobti, MD Dr .Twinkle Parmar, MD