Autologous serum eye drops in severe post-LASIK dry eye.

Alberto Arntz MD, Andrea Cruzat MD, Arturo Grau MD.Pontificia Universidad Católica de Chile

The authors have no financial interest in the subject matter of this poster.Autologous serum eye drops are not FDA aproved.

Purpose

To evaluate the efficacy and safety of Autologous Serum eye drops for the treatment of severe post-LASIK dry eye syndrome.

MethodsInclusion Criteria

• Patients with no previous dry eye history, who underwent uneventful LASIK and presented severe dry eye signs 4 weeks after surgery in spite of conventional unpreserved artificial tears therapy.

• Severe dry eye diagnosis was stablished when the patient met all three criteria:– 2 lines lost of best-spectacle corrected visual acuity (BSCVA).– Corneal fluorescein staining score (FSC) ≥ 1.– Residual astigmatism ≥ 1.0D

MethodsCorneal Fluorescein Staining Score (FSC)

Diffuse and complete corneal staining4

Confluent inferior 1/2 corneal surface staining3

Confluent inferior 1/3 corneal surface staining2

Isolated punctate staining1

No staining0

MethodsRecruitment and Follow-up

- Recruitment during one year period.- Patients who met inclusion criteria were enrolled after

informed consent.- Autologous serum was obtained and prescribed 6 times a

day for 1 month.- 3 months follow-up with monthly visits.- Parameters evaluated every visit:

Best-corrected visual acuity (BCVA)Residual refractive astigmatism (RA)Corneal fluorescein staining score (FSC)

Adverse effects

MethodsAutologous Serum preparation

• 100 ml of venous peripheral blood collected and clotted at room temperature for three hours.

• Centrifuge for 10 minutes at 3000 rpm.• Supernatant serum extraction and dilution to 20% in

balanced salt solution.• Portions of 5 ml aliquoted into sterile dropper bottles,

and labelled with name of the patient and date of production.

• Bottles stored frozen at -20ºC.• Every bottle used for 1 week, 6 times a day, stored at 6ºC

and discarded after that period.

Results

• After recruitment period of 1 year, 14 eyes (8 patients) who met the inclusion criteria were enrolled from nearly 500 LASIK procedures.

• 100% women.• Mean age: 33 ± 9 yo.• Preoperative spherical equivalent: 2.6 ± 3.5 D (

range +3.7 to -7.75 ).• No adverse effects were observed.

ResultsBSCVA

Change in BSCVA after LASIK surgery. The green and red arrows represent the beginning and the end of the AS period of treatment.

ResultsResidual Astigmatism (RA)

Change in RA after LASIK surgery. The green and red arrows represent the beginning and the end of the AS period of treatment.

ResultsFluoresceinic Staining Score (FSC)

Change in corneal FSC after LASIK surgery. The green and red arrows represent the beginning and the end of the AS period of treatment.

<0.0051.1 ± 0.372.1 ± 1.03Corneal fluorescein staining score

<0.050.7±0.120.55 ± 0.20BSCVA

Non significant0.63 ± 0.471.15 ± 0.84

Residual Astigmatism

(diopters)

pPostPre

Results: Main Outcome measures

Main outcome measures pre and post autologous serum treatment: BSCVA= best spectacle corrected visual acuity in snellen equivalent; Values presented as media ± standard deviation. P = statistical level of significance.

Conclusions• Our study suggests that autologous serum is a safe and

effective alternative that improves visual function and reduces ocular surface damage in severe post-LASIK dry eye unresponsive to conventional non-preserved artificial tears.

• A slight regression in the corneal epithelial fluorescein staining score after AS withdrawal suggests that treatment time should be longer than four weeks.

• Long prospective doble-blind studies are needed to confirm our study results.