Below are the chronological photos (meibographies) of our first case of PRP injection into the Meibomian Glands (3 injected).
As you can see below, many central glands were absent prior to PRP injection. After PRP injection the glands seem to have grow back.
The question remains: was this from just the probing and expression or did the PRP injection really make the difference. I believe it was the PRP injection as she had probing done before in this eyelid without much improvement.
Here are more details:
Notice the dates below:
BEFORE PRP INJECTION: RIGHT LOWER LID
ABOVE: This is how her meibomian gland in her right eyelid looked before PRP injection but after probing and expression.
BEFORE PRP INJECTION: RIGHT LOWER LID
BELOW:
AFTER PROBING, EXPRESSION, PRP INJECTION: PRP ONLY INJECTED INTO RIGHT LOWER LID INTO MISSING GLAND AREA;
Below I was able to put the near-infrared (NIR) illumination of the PRE-PRP and POST-PRP side by side so you can see the difference.
On the left is the original Meibography. You can see the black spot on the bottom scan which we think represents scarred, “never to come back” glands.
On the right, at the bottom, you can see that the black area is “filling in” as if the glands are coming back and working to produce oil.
And now look at today’s Meibography of the right lower lid below: 9/12/2017. The gland has grown back fully. This is very exciting!
THIS IS AFTER PRP INJECTION:
This patient has early Sjogren’s Syndrome so time will determine if this improved gland function will relieve all her pain. She is very young and came in with 10/10 eye pain on a daily basis. She used to spend 8-9 hours on the computer and did not know she had markers on her Sjogren’s panel when she first came in. Now she is being treated with Plaquenil and her pain scored have improved to a 6-7/10. She recently ate “a lot of gluten” in the form of pizza and bread and she says her pain went up to a 7-8/10. I have heard this from many patients but I have not seen it published that gluten can make the dry eye symptoms worse so dramatically. Still I do recommend a gluten free diet for dry eye patients.
The results of the PRP injection look promising. More studies are needed. Currently we are about to sign up for a Stem Cell Research Protocol as I know I can get the stem cells into the meibomian glands with our current protocol. While all these protocols are experimental, the alternative of continued loss and scarring of the glands is devastating. I recently saw a 21 year old woman with no glands in any lids. I will post that shortly. She is desperate as she has pain more than 18 hrs per day: the eye pain wakes her up from sleep. Her options are few. There are no guarantees even with PRP or Stem Cell injections, which makes this a frustrating disease for everyone involved!
Still I have hope. This patient has noticed some improvement in her symptoms with just one PRP injection. I pray future research will prove PRP and Stem Cell Injections into the Meibomian Glands to be a ground breaking treatment for Dry Eye Disease.
Sandra Lora Cremers, MD, FACS
Again:
——
BEFORE PRP Injection:
See this big empty area in the center of the lid? These were the glands that were injected with the patient’s own PRP.
——
AFTER PRP INJECTION:
Look at just the lower lid as that is the one whose central missing glands were injected.
