Elsevier

Ophthalmology

Volume 106, Issue 10, 1 October 1999, Pages 1984-1989
Ophthalmology

Treatment of persistent corneal epithelial defect by autologous serum application

https://doi.org/10.1016/S0161-6420(99)90412-8Get rights and content

Abstract

Objective

To evaluate the efficacy of autologous serum application for the treatment of persistent epithelial defect.

Design

Prospective, clinical, noncomparative case series.

Participants

A total of 16 eyes were studied.

Intervention

Autologous serum was prepared from the patients and diluted to 20% by saline. The patients were instructed to use the autologous serum six to ten times a day. The concentration of vitamin A, epidermal growth factor (EGF), and transforming growth factor-β (TGF-β) was measured at 1 week and 1 month stored in the refrigerator and 1 month and 3 months in the freezer.

Main outcome measures

Time to closure of epithelial defect.

Results

Vitamin A, EGF, and TGF-β were stable during the 1 month in the refrigerator and 3 months in the freezer. Among 16 persistent epithelial defects, 7 (43.8%) healed within 2 weeks, 3 (18.8%) healed within 1 month, and the remaining 6 (37.5%) did not respond within 1 month. No apparent side effect of autologous serum application was observed.

Conclusions

Autologous serum application healed 43.8% of persistent defect within 2 weeks and 62.5% within 1 month.

Section snippets

Patients with persistent epithelial defect

We defined PED as “a corneal epithelial defect persisting more than 2 weeks without improvement despite conventional treatment such as artificial tears or extended wear soft contact lenses.” A total of 16 eyes of 15 patients were diagnosed with PED and were recruited for this study (Table 1). The original diseases involved six patients with cicatricial keratoconjunctivitis sicca (three ocular pemphigoid and three Stevens-Johnson syndrome; two males and four females; mean age, 62.5 ± 16 years),

Stability of tear components in 20% diluted serum

The concentration of vitamin A, EGF, and TGF-β stored in the refrigerator is listed in Table 2 and that stored in the freezer is listed in Table 3. The concentration of these factors was stable for 1 month in the refrigerator (4° C) and for 3 months in the freezer (−20° C). Statistical analysis was performed by the ANOVA test.

Tear dynamics and corneal sensation

The average Schirmer test result was 6.3 ± 6.0 mm (Table 1), which suggested the presence of dry eye. The average Schirmer test with nasal stimulation was 7.2 ± 6.1 mm,

Case report

A 40-year-old Japanese man had bone marrow transplantation for the treatment of chronic myeloblastic leukemia on June 27, 1996. He developed chronic graft-versus-host disease with liver dysfunction 6 months after the bone marrow transplantation and suffered from dry eye and frequent rashes of the skin. He visited our department on July 10, 1997, reporting severe photophobia (painless) and red eye. He was barely able to open his eyes, and conjunctival injection was severe. The corneal epithelium

Discussion

We have reported the efficacy of autologous serum application for the treatment of persistent corneal epithelial defect in the patients with various underlying disease. Although there was no control in this study, the defects had persisted for at least 2 weeks, with an average of 6.8 months before treatment, and healing was achieved within 2 weeks in the “effective group” after initiation of autologous serum treatment. When we consider the partially effective groups as successful as well,

References (32)

  • K. Tsubota et al.

    Decreased reflex tearing is associated with lymphocytic infiltration in lacrimal glands

    J Rheumatol

    (1996)
  • K. Tsubota

    New approaches in dry eye management. Supplying missing tear components to the ocular surface epithelium

  • T. Nishida et al.

    Synergistic effects of substance P with insulin-like growth factor-1 on epithelial migration of the cornea

    J Cell Physiol

    (1996)
  • T. Nishida et al.

    Fibronectin. A new therapy for corneal trophic ulcer

    Arch Ophthalmol

    (1983)
  • Y. Ohashi et al.

    Presence of epidermal growth factor in human tears

    Invest Ophthalmol Vis Sci

    (1989)
  • J.L. Ubels et al.

    Retinol secretion by the lacrimal gland

    Invest Ophthalmol Vis Sci

    (1986)
  • Cited by (335)

    View all citing articles on Scopus

    Supported by the Japanese Ministry of Health and Welfare, Tokyo, Japan, and by the grant of Hightech Research Center at Tokyo Dental College, Ichikawa, Japan. Also supported by the Medical School Faculty and Alumni Grants of the Keio University Medical School, Tokyo, Japan.

    View full text