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Application of Autologous Serum Eye Drops in Aniridic Keratopathy
autologous serum over the epithelial surface that diminished the squamous metaplasia improved significantly in all eyes, but in group
inflammation and stimulation of the blood vessels. D eyes the goblet cells remained after the treatment. These findings
resulted in all of the patients showing a subjective clinical
Dry-eye severity was correlated with the keratopathy grade. In these improvement after the autologous serum therapy in comparison with
patients, the aqueous layer produced by lacrimal glands did not the prior treatment with artificial tears. All patients showed a
change, as demonstrated by the normal Shirmer’s test in all patients subjective improvement in photophobia, epiphora and foreign body
except the most severe eyes. By contrast, BUT was altered in sensation after the treatment, except those in group A.
practically all patients. This test measures tear stability, but it is a
non-specific test that is altered in all dry-eye types. Autologous Conclusion
serum eye drop treatment significantly improved Schirmer and BUT Autologous serum has biochemical and biomechanical properties
levels in all patients. After the treatment, only eyes with severe similar to those of normal tears, is non-allergenic and has antimicrobial
keratopathy showed pathological levels in BUT and Schirmer’s test. and optic properties. It contains epitheliotrophic factors that are
The autologous serum effect was more important in the BUT cohort thought to be responsible for the therapeutic effect over ocular surface
because these levels were pathologically diminished in all eyes disorders. In this work, we found that the autologous serum eye drops
except group A. We think that the autologous serum effects on mucin improved aniridic keratopathy in all patients, but especially in patients
expression, meibomian dysfunction and epithelial surface improved with slight or moderate severity. In these patients, autologous serum
tear stability and BUT levels. The fluorescein stain also showed better eye drops were superior to conventional therapy with substitute tears
tear stability and an increase in tear meniscus level after treatment in terms of improving ocular surface and subjective comfort. n
with autologous serum (see Figure 2). Fluorescein and rose bengal
staining patterns of the cornea improved after treatment.
José Santiago López-García works in the Ophthalmology
Department of Cruz Roja Hospital in Madrid. His
The corneal epithelial cell squamous metaplasia obtained by research activity has focused on clinical and
impression cytology analysis correlated with keratopathy severity.
histopathological studies of ocular surface disorders. He
has published more than 50 articles, 17 of which are
Metaplasia was present in all patients in this study; even the group A
included on the Medline database. Dr López-García’s
eyes, without keratopathy symptoms, showed a grade 2 squamous reports have been published in Ophthalmology, Cornea
metaplasia. Corneal conjunctivalisation, defined by goblet cell
and the European Journal of Ophthalmology. He is
interested in the study of aniridic keratopathy as
presence in corneal cytology, was common in group C and D eyes.
indicative of primary limbal deficiency, and has written a doctoral thesis on aniridic
The presence of goblet cells on the corneal surface is considered to keratopathy management. Dr López-García’s aniridia research has twice been
provide clinical evidence of limbal stem cell deficiency. After two
honoured by the Spanish Aniridia Association.
months of autologous serum eye drop treatment, the epithelial
1. Nelson LB, Spaeth GL, Nowinski TS, et al., Aniridia. A review, eyes, Ophthalmology, 2005;112:1535–40. in Ophthalmology, Arch Soc Esp Oftalmo, 2007;82(1):9–20.
Surv Ophthalmol, 1984;28:621–42. 5. Rivas L, Murube J, Rivas A, Murube E, Impression cytology 8. Murube J, Rivas L, Impression cytology on conjunctiva and
2. Ramaesh K, Ramaesh T, Dutton GN, Dhillon B, Evolving study of dry eyes patients with congenital aniridia, Arch Soc cornea in dry eye patients establishes a correlation
concepts on the pathogenic mechanisms of aniridia Esp Oftalmol, 2003;78:615–22. between squamous metaplasia and dry eye clinical
related keratopathy, Int J Biochem Cell Biol, 2005;37:547–57. 6. Geerling G, Maclennan S, Hartwig D, Autologous serum eye severity, Eur J Ophthalmol, 2003;13:115–27.
3. López-García JS, García Lozano I, Rivas L, Martínez drops for ocular surface disorders, Br J Ophthalmol, 9. Mackman G, Brightbill FS, Optiz AK, Corneal changes in
Garchitorena J, Aniridic keratophaty management, Arch Soc 2004;88:1467–74. aniridia, Am J Ophthalmol, 1979;87;497–502.
Esp Oftalmol, 2006;81(8):435–44. 7. López-García JS, García-Lozano I, Rivas L, Martínez-
4. Jastanciah S, Al-Rajhi AA, Association of aniridia and dry Garchitorena J, Autologous serum eye drops applications
Editor’s Recommendation
Autologous Serum Eye Drops for the Treatment of Dry Eye Diseases
Kojima T, Higuchi A, Goto E, Matsumoto Y, Dogru M, Tsubota K, Cornea, 2008;27(Suppl. 1):S25–30.
Conventional treatment of dry eye mainly consists of the use of limbic keratoconjunctivitis, keratoconjunctivitis sicca and
preservative-free artificial eye drops and punctal occlusion. neurotrophic keratopathy. However, there is some controversy
None of the commercially available artificial tear preparations regarding the efficacy of AS treatment. We demonstrated that
includes essential tear components such as epidermal growth this modality is more effective than artificial tears in a
factor, hepatocyte growth factor, fibronectin, neurotrophic randomised controlled study. In in vivo and in vitro experiments,
growth factor and vitamin A – all of which have been shown to AS eye drops showed marked suppression of apoptosis in the
play important roles in the maintenance of a healthy ocular conjunctival and corneal epithelium. Albumin, the major protein
surface epithelial milieu. We reported previously that in serum, improved ocular surface damage in vivo and rescued
autologous serum (AS) eye drops contain these essential factors apoptosis after serum deprivation in vitro. The biological
and that AS eye drops are beneficial in the treatment of ocular background of AS eye drops and previous clinical studies of
surface diseases such as persistent epithelial defects, superior these medications for the treatment of dry eye are discussed. n
EUROPEAN OPHTHALMIC REVIEW 53
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