Ophthalmology Update - Cleveland Clinic

Autologous Serum Eyedrops May Offer Effective
Therapy for Patients with Intractable Ocular
Surface Disorders
Treatment of severe ocular surface disorders
remains a challenge, and in some patients,
the disorder is refractory to conventional interventions.
For them, Cole Eye Institute
ophthalmologist Bennie H. Jeng, M.D., has
found that the topical use of autologous
serum is a safe and often highly effective
modality for affording symptomatic relief
and/or promoting ocular surface healing.
relative to tears, autologous serum contains a similar
spectrum of growth factors, vitamins and immunoglobulins
that have positive epitheliotrophic
activity, and the concentrations of some of those
components in autologous serum exceeds that found
in tears. Over the past 2 years, dr. Jeng has used
autologous serum eyedrops to treat approximately
25 patients with a variety of ocular surface conditions
that were intractable to more conventional
therapies. the diagnoses in those patients included
persistent epithelial defects secondary to a variety
of etiologies as well as severe, chronic dry eye, often
associated with chronic graft-versus-host disease.
some patients with recurrent erosion syndrome
are also candidates for treatment with autologous
serum eyedrops.
Follow-up in those cases showed that improvement,
measured as a reduction in symptoms and/or as
epithelial repair, occurred fairly rapidly, within the
first few weeks of treatment, while complete healing
of epithelial defects was observed most of the time
within 4 weeks. Overall, the efficacy rate for autologous
tears has been 80% to 90%, reports dr. Jeng.
“While that still leaves us with a 10% to 20% failure rate,
considering that these are intractable cases of eyes
that have otherwise reached the end of the therapeutic
line, the outcomes achieved with autologous
tears are really quite impressive,” he says.
candidates for this experimental therapy are screened
to exclude people with hepatitis or hiv infection.
eligible patients have their blood drawn at cleveland
clinic. the sample is then spun down, and the sepa-
BEFORE
AFTER
rated serum is shipped to a pharmacy in california for
further processing and purification. the prepared autologous
serum eyedrops are shipped to the patients’
homes packaged in small containers that are kept frozen
until time for use.
in recent years, there has been an increase in reports
in the literature describing autologous serum eyedrops
as a treatment for ocular surface disorders. the
majority of those investigators have used autologous
serum that has been diluted to 20% with the addition
of normal saline. however, dr. Jeng has the pharmacy
prepare a 50% autologous serum formulation for
his patients.
“not only does this provide a higher concentration of
the epitheliotrophic factors, but it is also more viscous,
and that thicker consistency offers an additional
soothing effect when instilled into the eye,” he says.
Continued on page 18
i n v e s t i g a t i O n s
Figure 1: Eye prior to treatment
with autologus serum.
Figure 2: Same eye after
treatment.
c O l e e y e i n s t i t U t e c l e v e l a n d c l i n i c . O r g / e y e //