# Injectable platelet-rich fibrin for corneal epithelium healing: An in vivo confocal microscopy study after crosslinking

## TL;DR

Injecting platelet-rich fibrin speeds up corneal healing and improves nerve recovery after a crosslinking treatment for keratoconus.

## Contribution

Demonstrates that subconjunctival injectable platelet-rich fibrin accelerates epithelial healing and promotes nerve regeneration after corneal crosslinking.

## Key findings

- Injectable platelet-rich fibrin reduced epithelial defect closure time by nearly a day compared to the control group.
- Injectable platelet-rich fibrin significantly increased subbasal nerve plexus and keratocyte densities over three months.
- No complications were observed in the injectable platelet-rich fibrin group, unlike the control group which had a sterile infiltrate.

## Abstract

This study was conducted to investigate the effect of injectable
platelet-rich fibrin on the recovery of compromised epithelium due to
crosslinking treatment.

In this comparative study, the epithelial closure rates and in vivo confocal
biomicroscopy results of 26 patients with keratoconus who underwent
subconjunctival injection of injectable platelet-rich fibrin near the limbus
after epithelium-off corneal crosslinking treatment were compared with those
of 25 patients who did not receive the injection of injectable platelet-rich
fibrin.

The average time to epithelial defect closure in the injectable platelet-rich
fibrin group was 2.76 ± 0.90 days compared to 3.56 ± 0.86 days
in the non-injectable platelet-rich fibrin group (p=0.003). At the end of
the 1st month, the mean subbasal nerve plexus density was 1.26 ± 1.61
nerves/mm2 in the injectable platelet-rich fibrin group,
whereas it was 0.72 ± 0.89 nerves/mm2 in the
non-injectable platelet-rich fibrin group (p=0.016). By the 3rd month, the
density increased to 3.42 ± 1.13 nerves/mm2 in the
injectable platelet-rich fibrin group and 2.36 ± 1.15
nerves/mm2 in the non-injectable platelet-rich fibrin group
(p=0.002). Similarly, the anterior stromal keratocyte density at the end of
the 1st month was 93.6 ± 33.5 cells/mm2 in the injectable
platelet-rich fibrin group compared to 67.3 ± 26.4
cells/mm2 in the non-injectable platelet-rich fibrin group
(p=0.001). By the end of the 3rd month, the density increased to 255.2
± 45.7 cells/mm2 in the injectable platelet-rich fibrin
group and 222.1 ± 43.6 cells/mm2 in the non-injectable
platelet-rich fibrin group (p=0.011). In the non-injectable platelet-rich
fibrin group, one patient developed a sterile infiltrate at the end of the
1st week, whereas no complications were observed in the injectable
platelet--rich fibrin group.

Subconjunctival injectable platelet-rich fibrin application is an effective
and safe method for corneal epithelial healing after crosslinking
treatment.