AUTOLOGOUS SERUM-BASED EYE DROPS FOR TREATMENT OF OCULAR SURFACE DISEASE

A Report by the American Academy of Opthalmology

�The first ophthalmic use was reported in 1975 for the treatment of ocular burn using an ocular perfusion pump to deliver a variety of solution, including serum or plasma to the ocular surface.

After further studies showed patient improvement, the used of serum tears for ocular surface disease become more widely accepted.

INTRODUCTION

In 1984, the topical use of serum for the treatment of Sjogren’s related dry eye was reported and all of the patients noted improved symptoms, and no adverse events were reported.

Over the past 20 years, treatment of ocular surface disease using autologous serum tears has expanded.

PURPOSE

To describe the safety and effectiveness of using autologous serum-based eye drops for the treatment of severe dry eye and persistent corneal epithelial defect.

METHODS

• Based on literature search.

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• The search identified 281 citations.

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• Of these, 48 selected for a full-text-review.

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• This analysis included 14 studies which met the inclusion criteria:

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1. The study had to have 1 month or more follow-up

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• The study population had to include 20 or more patients treated for severe dry eye disease or 15 or more patients treated for nonhealing epithelial defect.

Composition & Function of the Serum

• VITAMIN A
• EPITHELIAL GROWTH FACTOR
• CYTOKINES

facilitate the recovery of damaged corneal and conjunctival epithelium, thus reducing the signs and symptoms of ocular surface disease (OSD).

PUBLISHED REPORT

Table 1 : Summary of Included Studies (Ophthalmology Volume 127, Number 1, January 2020)

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Table 2: Autologous Serum Results

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DED ¼ dry eye disease; NR ¼ not reported; PED ¼ persistent epithelial defect.

Table 2. Autologous Serum Results

DED ¼ dry eye disease; MGB ¼ microbial growth in bottle; NA ¼ not applicable; NR ¼ not reported; PED ¼ persistent epithelial defect; SS ¼ Sjögren’s syndrome; SSI ¼ statistically significantly improved.

*Percent autologous serum used.

^yNo clinical infection.

^zCorrelated with microbe in corneal lesion.

Shtein et al

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Ophthalmic Technology Assessment

• 8 of the studies reported side effects or adverse events
• 1 of the studies reported visual acuity results with no changes noted after treatment
• 1 study reported an adverse event of microbial growth measured in an eye drop bottle with no clinical sequelae

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• One study compared serum concentrations of 50% versus 100% and found that the 100% concentration was more effective in patients with Sjögren’s syndrome yet was not better for other types of severe dry eye

SEVERE DRY EYE DISEASES CASE STUDIES

Another study compare then treatment effectiveness in primary versus secondary Sjogren’s syndrome and suggested that autologous serum based eye drops work better for patients with primary Sjogren’s syndrome.

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A different study compare the diluent (normal saline vs sodium hyaluronate) and showed no statistical difference

SEVERE DRY EYE DISESES CASE STUDIES

NONHEALING CORNEAL EPITHELIAL DEFECT

• 4 studies evaluated the use of autologous serum-based eye drops for the treatment of persistent corneal epithelial defect

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• All showed substantial improvement in the epithelial defects and 3 showed a reduction of more than 90% in the size of the defects

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2 with level II evidence

2 with level III evidence

• A study comparing 50% versus 100% serum concentration found faster closure of the epithelial defects in patients using the 100% concentration eye drops

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NONHEALING CORNEAL EPITHELIAL DEFECT

• 1 study, a patient experienced a recurrence of the epithelial defect when the serum-based eye drops were discontinued

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• 1 of the bottles of serum eye drops was found to have microbial growth that matched the bacterium (Serratia marcescens) cultured from the patient’s corneal lesion.

CONCLUSION

Although autologous serum-based tears may be effective in the treatment of severe dry eye and persistent epithelial defect, conclusions are limited owing to the absence of controlled trials.