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Applications of Autologous Serum Eye Drops in Aniridic Keratopathy
José Santiago López-García
Ophthalmology Service, Hospital Cruz Roja, Madrid
Abstract
Aniridia is an uncommon congenital bilateral disease that involves the cornea, anterior chamber, lens, retina and optic nerve. Corneal
changes in aniridic keratopathy include recurrent erosions of corneal epithelium, tear film instability, chronic pain, corneal vascularisation,
dry eye, progressive corneal opacification and blindness. The autologous serum contains a variety of growth factors, vitamins and
immunoglobulins, some of which are in higher concentrations than in natural tears. The growth factors and protein found in the serum may
help the proliferation, migration and adhesion of epithelial corneal cells. They are by nature non-allergenic and their biochemical and
biomechanical properties are similar to those of normal tears. The ocular surface, including corneal impression cytology
and tear film evaluation, of patients with congenital aniridia was studied prior to and after treatment with autologous serum eye drops.
Keywords
Aniridia, aniridic keratopathy, autologous serum eye drops, ocular surface, impression cytology, epitheliotrophic factors
Disclosure: The author has no conflicts of interest to declare.
Received: 25 February 2009 Accepted: 10 March 2009
Correspondence: José Santiago López-Garcia, Ophthalmology Service, Hospital Cruz Roja, Avenida Reina Victoria no. 26, 28003 Madrid, Spain. E: docsantilopez@hotmail.com
Aniridia is an uncommon congenital bilateral disease caused by epithelial corneal cells. By nature they are non-allergenic and their
mutation of the PAX6 gene. It is an ocular disorder that involves the biochemical and biomechanical properties are similar to those of
cornea, anterior chamber, lens, retina and optic nerve.
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Although normal tears. Autologous serum facilitates mucin expression, which
aniridic keratopathy has traditionally been attributed to limbal stem may contribute to the beneficial effects over the ocular surface in
cell deficiency, current evidence based on clinical observations and patients with dry eye.
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animal models of aniridia suggests that the proliferative potential of
limbal stem cells may not initially be affected and this corneal We think that the epitheliotrophic factors present in autologous serum
alteration may be related to an abnormality in the limbal stem cell can help to treat the corneal changes that occur in patients with aniridia
microenvironment.
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Corneal changes in aniridic keratopathy include by a stem cell microenvironment improvement. With this purpose, a
recurrent erosions and ulcerations of corneal epithelium, tear film prospective study of 26 eyes from 13 patients (seven males and six
instability, dry eye, chronic pain, corneal vascularisation, progressive females) with aniridic keratopathy before and after two months of
corneal opacification and blindness.
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autologous serum eye drops treatment was performed. The mean age
of the patients was 26±9.5 years (range nine to 48 years). Patients
Tears perform a vital role in maintaining the health of the corneal undergoing topical treatment, except preservative-free tear substitutes,
epithelium. They contain substances such as epidermal growth were excluded from the study. All patients underwent ophthalmic
factor (EGF), fibronectin, basic fibroblast growth factor (bFGF), examinations, including visual acuity, biomicroscopy, intraocular
vitamin A and other neural growth factors that are thought to pressure determination by Perkins’ tonometry, ophthalmoscopy and, in
maintain epithelial health; however, in dry eye the lack of tear some patients, ocular echography.
production results in the deprivation of these epitheliotrophic
factors. Tear film disorder and dry-eye syndrome have been The ocular surface examinations included corneal impression
reported in connection with congenital aniridia.
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cytology and tear film evaluation. For corneal cytology, strips of
cellulose acetate filter paper (Millipore HAWP304) were applied after
Serum is the fluid of blood devoid of its cellular components and topical anaesthesia over the four corneal quadrants for a few
clotting factors. It contains a variety of growth factors, vitamins seconds. The samples were processed and examined by light
and immunoglobulins, some of which are in higher concentrations microscope. The criteria used for corneal cytology diagnosis were
than in natural tears. Autologous serum eye drops have been based on cellular shape and size, nuclear size, cytoplasmic staining,
reported previously for the treatment of ocular surface diseases.
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nuclear changes, nuclear–cytoplasmic (N:C) ratio and corneal
Autologous serum provides epitheliotrophic factors such as EGF, conjunctivalisation. Corneal epithelial cells were graded according to
bFGF, vitamin A, fibronectin, α2 macroglobulin and neural growth the Murube and Rivas squamous metaplasia classification, which
factors that facilitate the proliferation, migration and adhesion of distinguishes several grades of squamous metaplasia with a range
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