Autologous serum eyedrops for dry eyes and epithelial defects: clinical and in vitro toxicity studies

Abstract

Background/aims-Autologous serum drops have been reported to be beneficial in keratoconjunctivitis sicca (KCS) and persistent epithelial defects (PED). A clinical pilot study was carried out to examine these potential uses and in vitro toxicity testing on corneal epithelial cell cultures was performed to compare the eVect of serum drops with unpreserved hypromellose (hydroxypropylmethylcellulose 0.3%). Methods-Patients with KCS and PED, unresponsive to conventional treatment were recruited. Patients were examined before treatment, at 1 and 2 weeks after initiation, and then 2 weekly until treatment ceased. Symptoms were assessed at each visit. Clinical examination included Schirmer's test without anaesthesia, rose bengal staining, and fluorescein staining. Epithelial defects were measured with the slit beam. In the laboratory, cultured human corneal epithelial cells were exposed to serum drops and hypromellose, and their viability evaluated with fluorescent viability staining (Calcein AM ethidium homodimer) and an ATP assay. Results-Autologous serum was used in 15 eyes of 13 patients with PED and 11 eyes of nine patients with KCS. In two patients serum drops were started after penetrating keratoplasty (PK). The PKs were performed for perforations secondary to PEDs. Of the 15 eyes with PED, nine healed at a mean of 29 days and six failed. The mean duration of PED before the use of serum drops was 48.2 days. Of the 11 eyes with KCS, six had improved subjective scores and fluorescein scores, and five had improved rose bengal scores after the use of serum drops. For the two patients who used serum eyedrops post-PK, there was a stable and intact epithelium at 1 week. Cessation of serum drops during the postoperative period led to deterioration in the subjective and objective scores in both patients. One developed a PED that responded to reinstitution of serum drops. The morphology and ATP levels of cultured epithelial cells exposed to serum were better maintained than those exposed to hypromellose. Conclusion-Autologous

Allogeneic serum eye drops for the treatment of persistent corneal epithelial defect

“…5,6 Topical autologous serum drops are used clinically and have been found to be beneficial for severe dry eyes and PED. 1,[5][6][7][8] To our knowledge, no in vivo studies have been published on the use of allogeneic serum to treat PED. However, in vitro studies showed allogeneic 6 and xenogeneic 5 serum accelerated the migration and proliferation of human corneal epithelium.…”

“…Moreover, our results are comparable to other autologous studies in PED. 5,6 In conclusion, allogeneic serum eye drops are safe and effective in treating PED. In patients who need serum treatment but whose autologous serum is unavailable or unsuitable for use, allogeneic serum offers a treatment alternative.…”

“…[1][2][3][4][5][6] Autologous serum has been found to contain vitamin A, epidermal growth factor, fibronectin, and transforming growth factor-b, which are important substances for corneal and conjunctival integrity. 3,4 However, autologous serum may be contraindicated or unavailable in infants, the elderly, patients with severe systemic bacterial infections or acute autoimmune disease, and those afraid of phlebotomy.…”

Sight and comfort: complex procedures in end-stage Stevens–Johnson syndrome

“…Although new treatment modalities such as amniotic membrane transplantation and autologous serum drops have arrived since this patient's treatment, they are not without failures. 6,7 Biological flaps and grafts to cover the cornea permanently eliminate pain and the need for topical medication and preserve the eye for later rehabilitation. 8 To the best of our knowledge, the use of a Cutler-Beardtype skin flap has not been described for this purpose.…”

Autologous serum drop-dependent re-epithelialisation following penetrating keratoplasty in chronic graft vs host disease

“…1,2 The incidence of visual symptoms in patients with endocarditis is 5%. 4 The frequency of moderate to severe visual loss in patients who develop CNV following bacterial endocarditis is high.…”