The use of autologous conditioned plasma (ACP) in the treatment of perforated corneal ulcer (case report)
Authors:   Budgetary Institution of the Chuvash Republic «Republican clinical ophthalmologic hospital» of the Ministry of Health of the Chuvash Republic, Cheboksary, Arsiutov D.G. ,   Budgetary Institution of the Chuvash Republic «Republican clinical ophthalmologic hospital» of the Ministry of Health of the Chuvash Republic, Cheboksary,   SAISVE «Postgraduate Doctors' Training Institute» of the Ministry of Health of the Chuvash Republic, Cheboksary,   Federal State Budgetary Institution «National Medical and Surgical Center named after N.I. Pirogov” of the Ministry of Health of the Russian Federation, Moscow, Kiriilov N.V. ,   Budgetary Institution of the Chuvash Republic «Republican clinical ophthalmologic hospital» of the Ministry of Health of the Chuvash Republic, Cheboksary, Nikolaeva T.Y. ,   Budgetary Institution of the Chuvash Republic «Republican clinical ophthalmologic hospital» of the Ministry of Health of the Chuvash Republic, Cheboksary
Published: November 2022

Purpose. To evaluate the effectiveness of a combined approach in the treatment of perforated corneal ulcers using autologous conditioned plasma (ACP). Material and methods. In the Republican Clinical Ophthalmological Hospital, 3 patients with a corneal ulcer were treated using ACP. Two patients with corneal ulcer without perforation, one patient with corneal ulcer with perforation. Two patients with a corneal ulcer without perforation, in addition to the standard conservative treatment, received a single application of ACP in the area of the corneal ulcer in several layers, a single subconjunctival injection of ACP. In both cases, the ulcerative process was stopped successfully. A technique for a combined approach to the closure of perforated corneal ulcers has been developed, including primary suturing of the corneal defect in the ulcer area in order to reduce the risk of fluid perfusion; restoration of the anterior chamber with sterile air; multilayer applications of autologous conditioned plasma into the ulcer area and, as it is filled with ACP, the coverage area is expanded to the entire cornea. On average, the coating consists of 5–7 layers with 20–30 sec. polymerization. It is important to remove excess autoplasma with a tupfer and prevent excesses from entering the conjunctival fornix, which minimizes the risk of displacement of the ACP film. Surgery is performed against the background of active antibacterial, antiinflammatory and keratoprotective therapy. Additionally, a soft contact lens was applied at the end of the operation. Results. During surgery, the closure of the perforation of the cornea with an ACP composite was achieved, a stable anterior chamber of the eyeball was noted, and there was no external filtration of the cornea. These results remained stable over the entire follow-up period of 1 month. Conclusions. A positive preliminary clinical result was demonstrated using a combined approach in the treatment of corneal ulcer complicated by perforation using autologous conditioned plasma. Application of ACP to the cornea contributed to the creation of a durable composite to block the perforation. After expanding the number of patients treated by this technique, we assume that this technique can be considered as an alternative for urgent treatment of perforated corneal ulcers without penetrating keratoplasty. Keywords: corneal ulcer with perforation, autologous conditioned plasma, platelet-rich plasma