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Purpose: To evaluate the therapeutic efficacy of platelet concentrates (PCs) as adjunctive enhancers and drug delivery carriers in patients with antibiotic-resistant microbial keratitis.

Methods: This prospective interventional case series included patients with microbial keratitis refractory to conventional antimicrobial therapy. Microbiological investigations, including corneal scrapings and cultures, were inconclusive or showed poor response to targeted treatment.

Autologous platelet-rich plasma (PRP) was administered subconjunctivally and/or topically as a regenerative adjuvant.

Patients continued on fortified topical antibiotics (e.g., moxifloxacin and amikacin), and systemic corticosteroids were introduced cautiously after infection control to modulate inflammation.

Clinical outcomes included epithelial healing time, reduction of stromal infiltration, visual acuity changes, and complication rates.

Result: A total of three eyes n = three patients were included.

All cases demonstrated favorable clinical outcomes following the combined therapeutic approach:

• Accelerated corneal re-epithelialization
• Reduction in stromal infiltration and inflammation
• Improvement in ocular symptoms (pain, redness, tearing)
• Structural stabilization of the cornea

Conclusion: No significant adverse events related to platelet concentrate therapy were observed.

Platelet concentrates appear to be a safe and effective adjunctive therapy in the management of antibiotic-resistant microbial keratitis. Their regenerative and anti-inflammatory properties, combined with their potential as drug delivery systems, may enhance treatment outcomes in refractory cases.

Larger controlled studies are required to confirm these findings and standardize therapeutic protocols.

Translational relevance: This study supports the integration of regenerative medicine approaches into infectious keratitis management, offering a novel strategy for difficult-to-treat cases.