Key points to remember

The PRGF (Plasma Rich in Growth Factors) is a promising innovation to treat dry eye, offering unique biological benefits and multiple clinical uses. Here are the key things to remember about this innovative treatment:

• Stimulates tissue repair through a prolonged release of growth factors: PRGF optimizes tissue regeneration by continuously releasing growth factors, and in the absence of white blood cells, which promotes both anti-inflammatory and anti-scarring effects.
• Safe and stable thanks to its net-shaped structure: The preparation of PRGF creates a 3D structure, like a net, without cells, exceptionally stable. This improves healing without causing unwanted inflammation.
• Clinical advantage over standard treatments: Compared to conventional eye drops, PRGF actively stimulates the production of cells that maintain eye humidity and visibly improves the condition and function of the eye surface.
• Effective after surgery: In addition to treating dry eyes, PRGF is effective for pain after LASIK surgery and corneal abrasions, making healing faster and more comfortable.
• Rigorous sampling and preparation protocol: Controlled centrifugation and the use of approved kits guarantee a standardized method, which is essential for obtaining reproducible and reliable results in the clinic.
• The importance of patient preparation for better outcomes: Good hydration and an appropriate diet before blood sampling significantly improve the quality and effectiveness of PRGF, an aspect that is often overlooked.
• Significant improvement in dry eye symptoms: Studies show a significant reduction in ocular surface damage and better stability of the tear film (the liquid that moistens the eye), increasing patient comfort and satisfaction.

PRGF represents an important advance in ophthalmology, transforming the management of ocular surface problems with a therapy that better mimics the body's natural processes and is more targeted. To fully understand the impact of this treatment, it is important to place it in the context of the treatment of dry eye.

In the following sections, we will detail its applications and the implications for doctors and patients.

Introduction

The treatment of dry eye is progressing rapidly thanks to biomedical advances. One of the most promising innovations is the Plasma Rich in Growth Factors (PRGF). This treatment, which uses the natural regenerative properties of blood, offers a unique and personalized approach to repair and protect the eye's surface when it is damaged.

Thanks to its anti-inflammatory, anti-scarring and restorative properties, PRGF is distinguished by its ability to improve the quality of life of people suffering from dry eyes, whether severe or due to surgery. Unlike conventional treatments, it acts in depth to promote cell regeneration, stabilize the tear film (the liquid that moistens the eye) and reduce persistent discomfort.

In this article, we will take a detailed look at the specific mechanisms of action of PRGF, its clinical benefits, and its therapeutic applications, to better understand this innovative treatment.

Composition and mechanism of action of PRGF

What is PRGF?

Plasma Rich in Growth Factors (PRGF) is a type of platelet-rich plasma (PRP) obtained from the patient's blood. Unlike other blood-derived products, PRGF is purified to contain only growth factors that come primarily from platelets, by eliminating white blood cells and other components that can cause inflammation. This characteristic makes PRGF particularly suitable for delicate treatments, such as eye treatments.

Mechanism of action of PRGF on the ocular surface

PRGF works thanks to a high concentration of active proteins, such as:

• Vascular Endothelial Growth Factor (VEGF), which promotes healing.
• Epidermal growth factor (EGF), which stimulates the regeneration of the skin of the eye.
• Platelet-derived growth factor (PDGF) and insulin-like growth factor (IGF-I), which accelerate cell renewal and tissue repair.

The combined action of these molecules contributes to:

• Regenerate tissue: they stimulate the multiplication and movement of cells from the surface of the cornea.
• Decrease inflammation: by removing the inflammation-causing substances responsible for the symptoms of dryness and irritation.
• Have a natural antimicrobial effect: which helps to prevent infections.

Simply put, PRGF acts as a biological “booster” that extracts the best elements from the blood to revitalize and heal damaged eye tissue. Concretely, this mechanism of action has different applications to treat various eye diseases.

Applications in Ophthalmology

PRGF for Dry Eye

Dry eye is common and is characterized by instability of the tear film (the liquid that moistens the eye) and inflammation of the surface of the eye. For patients with moderate to severe forms, PRGF-based drops (called ePRGF) have shown promising results:

• Improvement of symptoms: Reduction of 30 to 50% in the scores of questionnaires such as OSDI (which measures the severity of dry eye) after 3 to 6 months of use.
• Better tear film stability: The tear film rupture time (time before the eye dries) increases significantly, from an average of 3 to 6 seconds in some studies.
• Regeneration of the glands that produce protective mucus for the eye: By increasing the number of goblet cells, PRGF restores balance to the ocular surface.

Clinical Cases: Corneal Injuries and LASIK Surgery

PRGF is particularly effective in patients with corneal injuries or ulcers. For example:

• Treatment after LASIK: Patients treated with PRGF after refractive surgery recovered approximately 40% faster.
• Advanced corneal damage (neurotrophic keratopathy): In a clinical study, a disappearance of ulcers was observed in 90% of cases, with an improvement in corneal sensitivity.

Comparison with Classic Treatments

The benefits of PRGF exceed those of solutions such as autologous serum (patient serum) or artificial tears:

• Better tolerance: PRGF does not contain inflammatory proteins, such as IL-6 or TNF-alpha, which are often found in autologous serum.
• More effective: A study has shown that PRGF stimulates tissue repair twice as effectively as drops made from autologous serum.
• Adaptable use: Available in the form of drops, membranes, or injections, it adapts to various medical needs.

Given these clinical results, it is important to understand how PRGF is prepared and administered to optimize its benefits.

PRGF Preparation and Administration Protocol

Steps to prepare the PRGF

1. Blood sample: 50 to 70 ml of blood are collected in tubes containing a product that prevents coagulation (sodium citrate).
2. Controlled centrifugation: The blood is centrifuged at a low speed (about 580 g) to separate red blood cells from plasma that is poor in white blood cells.
3. Plasma activation: Calcium chloride is added to plasma to release growth factors.
4. Preservation: PRGF eye drops are packaged and stored at -20°C. Each bottle is stable for three months.

These techniques guarantee a sterile and safe preparation, eliminating the risks of immune reactions.

Administration: Method and Frequency

• Eye drops: 1 drop in each eye, 4 times a day for 3 months.
• Injections or membranes: Used for serious illnesses, they require clinical application by a professional.

Role of Patient Preparation

To optimize the effectiveness of the treatment, it is crucial that the patient is well prepared before blood sampling:

• Hydration: Drinking plenty of water 24 to 48 hours before improves plasma quality.
• Balanced diet: A diet rich in antioxidants (red fruits, spinach, nuts) can promote an optimal amount of growth factors.
• Temporary stopping of certain medications: Some anti-inflammatory medications need to be stopped temporarily to maximize the effects of PRGF.

These simple, but often forgotten, steps can improve benefits and reduce the risk of complications. In addition to patient preparation and the PRGF preparation protocol, it is important to consider the benefits and safety of PRGF compared to other treatments available.

Advantages and Security Compared to Alternatives

Advantages of PRGF

1. Natural origin (autologous): Since it comes from the patient's blood, PRGF eliminates the risk of rejection or allergy.
2. Proven safety: Heating to 56°C destroys pathogens, such as the IgE that cause allergies.
3. Versatility: Suitable for a variety of conditions, from simple dry eyes to persistent corneal ulcers.

Risks and Limits

Although generally very safe, PRGF may not be suitable for:

• For patients with significant coagulation problems.
• In case of active infections into the blood or nearby tissue.

Specific precautions should also be taken to ensure sterility, especially for injections.

By understanding the role, preparation and application of PRGF, we see that this technology could revolutionize eye care, offering an active and personalized biological solution to treat diseases that are often complex and invasive. In conclusion, it is important to summarize the benefits of PRGF and highlight its future potential in the field of ophthalmology.

Conclusion

Plasma Rich in Growth Factor (PRGF) represents a major advance in ophthalmology, thanks to its targeted action and its multiple applications. By promoting healing, reducing inflammation, and preventing infections, PRGF offers personalized and effective solutions for conditions ranging from dry eyes to serious corneal ulcers. Its superiority compared to conventional treatments, combined with increased safety and its natural origin (autologous), makes it a treatment for the future.

For ophthalmologists, optometrists, and patients, the use of PRGF marks a step towards more organic and personalized care. However, it remains essential to ensure thorough preparation and appropriate administration in order to optimize its clinical effectiveness.