Review of Cornea






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A Review of Autologous Serum

Autologous serum drops may be used to treat significant dry eye, RCE and neurotrophic keratitis.
By Paul M. Karpecki, O.D., and Diana L. Shechtman, O.D.

10/15/2011

The thought of drawing blood to create a solution that can be dropped into the eye seems odd, at best. But now, we are beginning to learn that autologous serum drops can be used to treat various ocular diseases both safely and effectively.

Research has shown that dry eye patients experience an improvement in corneal and conjunctival staining as well as symptom severity following instillation of autologous serum drops.1,2 These improvements have been noted as quickly as two to four weeks after initial use.1 And, because the biochemical properties of autologous serum drops are natural and similar to tears, they are extremely well tolerated.3

Blood and Tears
There is a significant biological overlap between blood serum and tears. More specifically, blood serum contains several essential tear film components, including epidermal growth factor, fibronectin, neurotrophic or nerve growth factor, and even vitamin A. Some or all of these tear film components are often depleted in patients with advanced cases of ocular surface disease.

Epidermal growth factor plays an important role in the regulation of cell growth and survival.4 Fibronectin is a high-molecular-weight glycoprotein that is integral to a healthy extracellular matrix. It binds key components, such as collagen, and is especially important for wound healing.5 Additionally, nerve growth factor is a protein that is critical for the growth, maintenance and survival of neurons; without nerve growth factor, apoptosis or cell death results.6

Obtaining Autologous Serum
Autologous tears are created by drawing a patient’s blood and then extracting the serum via centrifuge. The serum is mixed with artificial tears to create several autologous tear vials. Typically, a patient receives eight to 12 vials, which can be frozen and stored until required. One study indicated that freezing the drops effectively preserves the stability of essential autologous components, including epidermal growth factor, vitaminA and transforming growth factor beta.1 Also, no bacterial contamination has been documented in vials that were stored properly.7

In order to provide this service to your patients, typically you must first set up a blood draw with a lab. Then, the blood may be sent to either a compounding pharmacy or an eye bank (where corneal transplant tissues are processed and stored for most cities). Fortunately, many eye banks around the country are now offering this service.

Primary Applications
The first application of autologous serum was documented in 1984.7 In this study, autologous drops were used in 15 patients who were diagnosed with keratoconjunctivitis sicca (KCS).7

In addition to the treatment of KCS, patients with persistent epithelial defects, Stevens-Johnson syndrome and/or ocular cicatricial pemphigoid have exhibited significant benefit from the use of autologous drops.2,8

Further, autologous drops may help in the management of patients who present with neurotrophic keratitis secondary to herpetic disease, keratoplasty, refractive surgery, diabetes and chemical burns.9

Finally, several studies have indicated that autologous drops can be used to treat recalcitrant recurrent corneal erosion (RCE), superior limbic keratoconjunctivitis and graft-versus-host disease as well as less common conditions, such as Mooren’s ulcers and aniridic keratopathy.3,10,11
 In the original research for RCE, 11 patients had persistent episodes of erosion (a mean of 2.2 episodes per month).10 Just three of 11 patients treated with autologous drops experienced one breakdown during a three-month period.10 The other eight RCE patients had no episodes of recurrence.10

Of course, RCE is a long-term condition––so, three months of data may not be overwhelmingly telling. However, research in Greece on the long-term use of autologous serum drops in 33 RCE patients has been extremely promising.12 In this study, patients began using autologous serum drops when all previous treatment options for RCE failed. The patients dosed the autologous drops six times per day for three months, followed by q.i.d. for three additional months. Then, they discontinued the drops.

Following drop discontinuation, the researchers followed the patients for an average of 30 months. None of the patients experienced a recurrence during treatment. More remarkably, 85% of patients experienced complete healing of RCE with no recurrent episodes for 30 months following therapy.12 In fact, just five patients reported a single recurrence.12

Autologous Serum Alternatives
Some patients either cannot undergo proper blood draws or have insufficient volumes of blood to generate clinically viable autologous serum drops. In these cases, a compounding pharmacist may be able to create a tear drop with 5% albumin, which is one of the more important compounds found in blood plasma and tears.13

The use of “platelet-rich plasma” may be another alternative to autologous serum drops. Because blood that contains platelets provides a higher concentration of essential growth factors, it may yield an equally or more effective serum than albumin.14

Tears created with platelet-rich plasma have been tested successfully in patients with persistent epithelial defects, moderate to severe KCS, post-LASIK ocular surface syndrome and corneal perforation associated with amniotic membrane transplantation.15

In one study of 40 patients with persistent epithelial defects, 38 individuals showed significant improvement or complete resolution with the use of platelet-rich plasma drops. All patients reported reduced pain and improved vision.16


Optometrists often see patients who present with severe ocular surface disease. In some cases, conventional treatment options are ineffective. So, it is important to be aware of these blood-derived treatment options to provide optimal therapy for as many patients as possible.

Drs. Karpecki and Shechtman have no direct financial interest in any of the products mentioned.

1. Tsubota K, Goto E, Fujita H, et al. Treatment of dry eye by autologous serum application in Sjogren’s syndrome. Br J Ophthalmol. 1999 Apr;83(4):390-5.
2. Poon AC, Geerling G, Dart JK, et al. Autologous serum eyedrops for dry eyes and epithelial defects: clinical and in vitro toxicity studies. Br J Ophthalmol. 2001 Oct;85(10):1188-97.
3. Quinto GG, Campos M, Behrens A. Autologous serum for ocular surface diseases. Arq Bras Oftalmol. 2008 Nov-Dec;71(6 Suppl):47-54.
4. Herbst RS. Review of epidermal growth factor receptor biology. Int J Radiat Oncol Biol Phys. 2004;59(2 Suppl):21-6.
5. Grinnell F. Fibronectin and wound healing. J Cell Biochem. 1984;26(2):107-16.
6. Freeman RS, Burch RL, Crowder RJ et al. NGF deprivation-induced gene expression: after ten years, where do we stand? Prog Brain Res. 2004;146:111-26.
7. Fox RI, Chan R, Michelson J, et al. Beneficial effect of artificial tears made with autologous serum in patients with keratoconjunctivitis sicca. Arthritis Rheum. 1984 Apr;27(4):459-61.
8. Tsubota K, Satake Y, Ohyama M, et al. Surgical reconstruction of the ocular surface in advanced ocular cicatricial pemphigoid and Stevens-Johnson syndrome. Am J Ophthalmol. 1996 Jul;122(1):38-52.
9. Jeng BH, Dupps WJ. Autologous serum 50% eyedrops in the treatment of persistent corneal epithelial defects. Cornea. 2009 Dec;28(10):1104-8.
10. del Castillo JM, de la Casa JM, Sardina RC. Treatment of recurrent corneal erosions using autologous serum. Cornea. 2002 Nov;21(8):781-3.
11. Goto E, Shimmura S, Shimazaki J, et al. Treatment of superior limbic keratoconjunctivitis by application of autologous serum. Cornea. 2001 Nov;20(8):807-10.
12. Ziakas NG, Boboridis KG, Terzidou C, et al. Long-term follow up of autologous serum treatment for recurrent corneal erosions. Clin Experiment Ophthalmol. 2010 Oct;38(7):683-7.
13. Kojima T, Higuchi A, Goto E et al. Autologous serum eye drops for the treatment of dry eye diseases. Cornea. 2008 Sep;27 Suppl 1:S25-30.
14. AliĆ³ JL, Arnalich-Montiel F, Rodriguez AE. The Role of “Eye Platelet Rich Plasma” (E-Prp) for Wound Healing in Ophthalmology. Curr Pharm Biotechnol. 2011 Jul 8. [Epub ahead of print]
15. Alio JL, Pastor S, Ruiz-Colecha J, et al. Treatment of ocular surface syndrome after LASIK with autologous platelet-rich plasma. J Refract Surg. 2007 Jun;23(6):617-9.
16. Alio JL, Abad M, Artola A. Use of autologous platelet-rich plasma in the treatment of dormant corneal ulcers. Ophthalmology. 2007 Jul;114(7):1286-93.



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