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Impressum
Autologous serum for the treatment of persistent epithelial defects after penetrating keratoplasty
1Ferreira de Souza R., 2Kruse F.; 1Seitz B.
1Dept. of Ophthalmology University Erlangen-Nuernberg, Erlangen; 2Dept. of Ophthalmology University Heidelberg, Heidelberg
Purpose: To show our first results of topical autologous serum
for the treatment of persistent epithelial defects after penetrating keratoplasty
(PK) and to analyze the safety and efficacy of this new therapeutic modality.
Methods: Between November 1999 and March 2001, 35 eyes with epithelial
defects after PK refractory to conventional therapy (mean age 68±14
years) were treated with autologous serum. We investigated localization,
size and duration of defects, the time period until complete epithelial
closure in successful cases (</= 30 days) and the incidence of recurrences.
After centrifugal separation of freshly taken blood the serum (100% concentrated)
was kept in sterile dosing bottles at refrigerator temperature and was
applied at an hourly interval during day time. Further topical and systemic
medication was given according to the underlying diseases.
Results: On average, the epithelial defect was 5 mm long and 3
mm wide. All patients had been treated before with maximum topical therapy
(including hyaluronic acid) for 10±10 days. The period of autologous
serum treatment ranged between 4 and 38 days (13±9 days). In 28
of 35 eyes (80%) the epithelial closure was complete after 3 to 27 days
(average10±6 days). During a mean follow-up of 7±4 months,
17% of eyes had a recurrence after 4 to 38 days and were treated successfully
with secondary serum application (3x) or amniotic membrane transplantation
(1x). Seven eyes (20%) considered to be non-responding clinically were
treated with amniotic membrane transplantation (4x) or repeat PK (3x)
after 7, 8, 11, 14, 15, 36 and 38 days.
Conclusion: Autologous serum seems to be safe and efficient for
persistent epithelial defects after complicated PK thus avoiding more
invasive treatment modalities, such as botulinum toxin application, tarsorrhaphy,
amniotic membrane transplantation or repeat PK.