الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
The present study is a non-controlled non randamized clinical trial aimed to evaluate the safety and efficacy of autologous PRP in treatment of thirty patients with POH.
The mean age of studied cases was 27.1 ± 9.6 years and ranged from 18 to 47 years old. Out of 30 POH studied cases; 83.3% were females and 16.7% were males with Female: Male ratio of 5:1, 90% of studied cases were employees and 70% from urban areas.
All cases had gradual onset of disease, 66.7% had progressive and 33.3 % had stationary disease course, with median disease duration of 6 years and ranged from 3 up to11 years. Positive family history of POH was reported in 53.3% among studied patients while 13.3% had history of combined oral contraceptive (COC) use. Eyelid involvement was observed in all studied cases, five cases (17%) had visible bulging.
According to Wood’s lamp examination; 63.3% had epidermal pigmentation and 36.7% had dermal pigmentation. According to Ranu et al (2011) classification, the POH was constitutional in 63.3% and post-inflammatory in 36.7% of the cases.
As regard the grading of POH severity score, 56.6% had grade II, 30% had grade III, 6.7% had grade I and 6.7% had grade IV severity score.
Using a five point scale to evaluate the degree of clinical improvement of POH three months after treatment with three sessions of intradermal PRP in the periorbital area at monthly interval showed absence of any change (0%) in 33.3% of studied cases, slight improvement was reported in 23.4% (no/slight improvement, 55.7%), 40% had moderate improvement and only one patient (3.3%) had significant improvement (moderate/significant improvement (43.3%).
Regarding socio-demographic characteristics, there no significant association between socio-demographic characteristics and grades of improvement. Respecting clinical determinants, disease course and association between all clinical determinants and grades of improvement was delineated.
According to Wood’s lamp examination, moderate/significant grade of improvement was observed in 84.6% of those with epidermal compared to 15.4% among those with dermal pigmentation. Also, no/slight improvement was observed in 47.1% of those with epidermal compared to 52.9 % among those with dermal pigmentation (P =0.034).
Considering Ranu et al., classification, 84.6% of those with moderate/significant improvement were of the constitutional type of POH compared with 15.4 % of those with the post-inflammatory type (P =0.006).
Significant improvement on the severity score of POH after treatment was reported , grade I increased from 6.7% to 60% while grades II ,III and IV decrease from 56.6% , 30% and 6,7% to 13.3% ,23.4% and 3.3%,respectively after treatment (P<0.001).
Comparison of grades of clinical improvement of POH in relation to the pre-treatment POH severity score showed that 76.9% of those with moderate/significant improvement had grade I-II POH severity score compared to 23.1% among those with grade III –IV POH severity score. Also, 52.9 % of patients with no/slight improvement had grade I-II POH severity score compared to 47.15 of those with grade III –IV lesions (p=0.044).
Also , comparison of grades of clinical improvement of POH in relation to the post treatment POH severity score showed that 92.3%% of those with moderate/significant improvement had grade I-II POH severity score compared to 7.7 % among those with grade III –IV POH severity score . Also ,58.8 % of patients with no/slight improvement had grade I-II POH severity score compared to 41.2% of those with grade III –IV lesions (P=0.044).
As regard patient’s satisfaction, three months after completion of PRP injection sessions, 16.7 % were neutral, 20 % were pleased, 33.3% were satisfied and 30% were very satisfied with the outcome of PRP treatment sessions.
All cases had erythema, 60% had swelling and only 13.3% had ecchymosis in the periorbital area that all last for 1-2 days after each session and improved without treatment. Moderate pain was documented in 20.0% of the patients, 70% reported mild pain and 10% reported no pain at all.
In conclusion, the present results confirm the beneficial role of PRP in improvement of POH. Patients with epidermal pigmentation, constitutional POH and lower baseline disease grade of POH had significant improvement in comparison with those dermal pigmentation, post inflammatory POH and higher baseline grade severity of POH.