Br J Ophthalmol 2001;85:1188-1197
( October )
Autologous serum eyedrops for dry eyes and epithelial defects:
clinical and in vitro toxicity studies
Alexander C Poona, Gerd Geerlinga b, John K G Darta b, Graham E Fraenkela, Julie T Danielsb
a Moorfields
Eye Hospital, London, UK, b Institute of
Ophthalmology, London, UK
Correspondence to: Mr John Dart, Moorfields Eye Hospital, 162 City Road, London EC1V
2PD, UK jdart{at}ucl.ac.uk
Accepted for publication 14 February 2001
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 effect of serum drops with unpreserved hypromellose
(hydroxypropylmethylcellulose 0.3%).
METHODSPatients
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.
RESULTSAutologous
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.
CONCLUSIONAutologous
serum drops are useful for PED and KCS. This effect may be related to a
number of active factors in serum including growth factors,
fibronectin, vitamin A, and anti-proteases. In vitro toxicity testing
demonstrated that serum drops have reduced toxicity compared with
unpreserved hypromellose. Currently regulatory restrictions in the UK
have prevented the establishment of a prospective randomised controlled
trial examining the efficacy of autologous serum drops for the
management of this group of ocular surface disorders.
© 2001 by British Journal of Ophthalmology
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eLetters:
Read all eLetters
- Role of autologous serum in persistent epithelial defects
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- BJO Online, 4 Jul 2002
[Full text]
- Autologous serum in epithelial defects: Authors' reply
- John Dart, et al.
- BJO Online, 4 Jul 2002
[Full text]
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