We are continuing to see improvements in tear production and meibomian gland structure after PRP insertion into the meibomian glands. Only 1 in 8 patients did not get a symptomatic improment after PRP insertion within 1 week of the procedure.

I am wondering if PRP insertion with autologous stem cell insertion into the meibomian glands may be a better option for certain patient. I suspect that the stem cells may need a boost of growth factors at the time of insertion to help support stem cell differentiation.
We know that there are about 600 growth factors present in the PRP,1 which are crucial for  healing and promoting tissue regeneration. 


Activated PRP is key: activated platelets release an initial burst of growth factors and and then has a sustained release of growth factors. 

Could one’s stem cells need one’s PRP insertion at the same time? 


I suspect it might be needed in some patients. The right concentration would be an issue as well: should PRP be 50% and autologous stem cells be 50% or 20/80% or 10/90%? 


Some studies have shown that when stem cells are combined with PRP, they are able to promote new bone tissue or osteogenesis. The review below provides in-depth knowledge regarding the use of stem cells and PRP in vitro, in vivo and their application in non-ocular clinical studies. This review paper does not address its use in the eye. 


This is the new frontier of dry eye research. A frontier that desperately needs funding and well designed studies. The key issue is getting controls for such as study as no patients want to have “sham” (ie, pretend) stem cell insertions into their meibomian glands. 


In the meantime, we continue to study patients who have PRP or autologous stem cells insertion into the meibomian glands. I suspect we must start another treatment arm of PRP combined with stem cells. 


Sandra Lora Cremers, MD, FACS

References:

1. Application of platelet-rich plasma with stem cells in bone and periodontal tissue engineering

• Gabriela Fernandes
•  & Shuying Yang