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Sterility of Non-preserved Autologous Serum-drops for Treatment of Persistent Corneal Epithelial Defects
1Ferreira de Souza R., 2Blüthner K., 1Seitz B.,
1Friedrich-Alexander-Universität, Augenklinik (Erlangen)
2Friedrich-Alexander-Universität, Augenklinik, Kornea Bank (Erlangen)
Purpose: To investigate the sterility of non-preserved autologous serum drops in hospitalized patients with persistent corneal epithelial defects.
Methods: Thirty patients with persistent corneal epithelial defects (age between 28 and 85, mean 67±14 years) have been treated with autologous serum drops at 5 different floors of an University Eye Hospital between October 2001 and March 2002. After centrifugation of freshly taken autologous blood, the serum was stored in sterile drop bottles at refrigerator temperature (7°C) and applied undiluted each one or two hours up to 7 days. Using blood, chocolate, endo and Sabouraud agar media, we assessed the sterility of autologous serum drops on the day before application, on the fourth and on the seventh day (last day of application). Examinations performed on the first and fourth day included 40 autologous serum drops each and on the seventh day 120 samples (40 autologous serum drops, 40 bottle tops and 40 bottle bottoms). The agar media for bacterial examination were read after 48 hours incubation time, those for fungal examination were read after 21 days. All patients had received topical autologous serum therapy and prophylactic antibiotics drops for at least 7 days. Up to 30 days after the last day of treatment with autologous serum, the patients were observed for signs of ocular infections.
Results: The time period of autologous serum treatment ranged from 7 to 28 (10±5) days. On the first and fourth day autologous serum drops were sterile. On the seventh day, 3 out of 40 (7,5 %) samples were contaminated with staphylococcus epidermidis. Two of these contaminations were due to a combined serum drop and bottle top contamination (5%). A third case resulted from additional bottle bottom contamination (2,5%). None of the samples examinated showed signs of fungal infection. During application of autologous serum as well as within the follow-up period no patient showed any symptoms of ocular infection.
Conclusions: The application of autologous serum has proven to be a practicable therapy in patients with persistent corneal epithelial defects. In case drops are applied by instructed personnel the absense of contamination can be ensured up to the fourth day. By means of additional application of prophylactic antibiotics drops, infections may be avoided even if refrigerated non-preserved autologous serum is used up to seven days. (Supported in part by CAPES, Brasília, Brazil (R. Ferreira de Souza))