Autologous serum for otherwise therapy resistant corneal epithelial defects - Prospective study on the first 70 eyes

Purpose: The purpose of this prospective clinical pilot study was to evalua te the efficiency, practicability and safety of topical autologous serum fo r therapy resistant corneal epithelial defects. Methods: Between November 1999 and June 2001 autologous serum therapy was a pplied in 70 eyes of 67 consecutive patients (age 18 to 92 [average 59 +/- 18] years) with corneal epithelial defects refractory to standard clinical treatment at the Department of Ophthalmology University Erlangen-Nurnberg. We evaluated localization, size of the defect, time until epithelial wound closure and the incidence of recurrences in relation to the clinical diagno sis. The blood was obtained by venipuncture, centrifuged and the non-dilute d serum was filled in sterile bottles, kept in the + 4 degreesC refrigerato r and hourly applied during daytime. Simultaneous systemic and topical medi cation depended on the underlying disease. Results: In 45 eyes corneal epithelial defects appeared after penetrating k eratoplasty but in 25 eyes corneal epithelial defects were not related to a corneal transplant. The epithelial defect had a medium length of 4.2 +/- 2 .4 mm and a width of 3.0 +/- 1.8 mm. Previously, the patients had been trea ted with maximal topical therapy (including hyaluronic acid) for 13 +/- 11 days. Treatment with autologous serum lasted from 4 to 45 (mean 16 +/- 11) days. A complete corneal re-epithelialization was achieved in 57 of 70 eyes (81 %) after 3 to 45 (mean 15 +/- 12) days. Forty-eight of these 57 eyes ( 84%) had no recurrence during a follow-up of 12 4 months. In 9 eyes (116 %) a recurrent epithelial defect occurred one or two months after initial clo sure. These eyes were treated sucessfully with a second autologous serum th erapy (6 x), amniotic membrane transplantation (2 x) or repeat keratoplasty (11 x). Thirteen eyes (19%) without primary success of autologous serum ap plied for 11 to 50 days were finally treated successfully with amniotic mem brane transplantation (10 x) or repeat keratoplasty (3 x). Conclusion: In persistent corneal epithelium defects, autologous serum ther apy can be considered as an effective and practicable therapy without adver se reactions. Especially in eyes after complicated penetrating keratoplasty the prognosis may be improved and more invasive treatment modalities such as botulinum toxin injection, amniotic membrane transplantation or (repeat) penetrating keratoplasty may be avoided. Definitive determinants for the s uccess of this novel therapy have not been identified, yet. However, eyes w ith accompanying deep stromal defects do not seem to be good candidates.