Clinical Analysis Of The Topical Use Of Autologous Serum In Persistent Epithelial Defects

Object Persistent corneal epithelial defects (PED) is a formidable question confused the ophthalmologists. Autologous serum tears had been reported to be beneficial in the treatment of PED. This study is proposed to review the local indications and to examine the outcome of autologous serum tear usage.Methods From Dem.2004 to Dem.2007, 26 cases(26eyes) of PED inpatients in our hospital treated with topical autologous serum were identified and reviewd. The patients were divided into 2 groups: Group A, persistent corneal defects 9cases (9eyes), including males 5cases(5eyes)(55.6%) and females 4cases (4eyes) (44.4%).The youngest patient was 27 years old while the oldest was 76 years old, the average age was 47.6 years old. The shortest time of therapy was 11 days while the longest was 33 days, the average was 19.9days. Group B, persistent corneal epithelial defects with stromal thinning 17 eyes,including males 12cases (12eyes)(70.5%) and females 5cases (5eyes)(29.5%). The youngest patient was 28 years old while the oldest was 80 years old, the average age was 51.4 years old. The shortest time of therapy was 6 days while the longest was 48 days, the average was 24.7days.Observe the changes of symptoms and physical signs after the use of autologous serum tears in PED patients. Therapy approach: the preparation and application of autologous serum, the serum was prepared by taking 5ml of peripheral blood from the patient under aseptic technique. The blood was allowed clotting for 1 hour at room temperature, then centrifuged for 5min at 1500 revolution/min. The serum was separated and diluted to 20% with sterile saline. Then stored at 4 degrees centigrade in the refrigerator. The patients were instructed to use the autologous serum 4 to 6 times a day. Therapeutic effect evaluation: Group A, adopted the standard by Tsubota. Effective if the epithelial defect healed within 2 weeks, partially effective if there was a tendency to heal within 2 weeks and healing achieved in 1 month, and ineffective if healing was not achieved in 1 month. Group B, curing: no ocular complaints, cornea epithelial defect healing, negative of fluorescein staining; improve: eye symptoms decreased, cornea epithelial defect and vertical extent superficial; inefficacy: eye symptoms and objective sign not relieve or aggravate.Result Group A, 9 cases (9eyes)persistent corneal epithelial defects, 4cases (4eyes)(44.4%) were cured within 2weeks, 3cases (3eyes)(33.3%) were cured within 4 weeks and 2cases (2eyes) (22.2%) were not cured within 1 month. The visual acuity raise different degree in 6cases (6eyes) (66.7%).No side effect or secondary infections were detected. During the follow up period,1 case(1 eye)recurred, then cured after autologous serum treatment for 9days. No recurrence again. Group B, 17 cases (17eyes) persistent corneal epithelial defects with stromal thinning, 9cases (9eyes) (52.9%) were cured after 6 to 38 days treatment (average 31days). 7cases (7eyes)(41.2%) were improved. Only 1 case (1eye)was invalid ,then undergone the conjunctival flap masking operation. The visual acuity raise different degree in 10 cases (10eyes)(58.8%).No side effect or secondary infections were detected. During the follow up period, there was no recurrence. Conclusion 1. The use of autologous serum is a safe and effective therapy in the treatment of PED. Serum has been shown to contain essential tears components in comparable concentrations to natural tears. The biomechanical and biochemical properties of autologous serum are similar to normal tears. Serum contains components such as growth factors, fibronectin, and vitamins to support proliferation, migration, and differentiation of the corneal epithelium. Fibronectin is a large molecule protein. It is an adhesive glycoprotein, which is a normally occurring component of the basement membrane. In addition to its activity as a binding agent that promotes cell-to-cell and cell-to-substrate adhesion, FN also plays a role in cell migration, wound healing, and cytoskeletal organization. Therefore, it may promote healing by providing the attachment for regenerating epithelial cells and by acting as a stimulus for migration of these cells.2. The usage of autologous serum in the later stage of infected corneal ulcer can accelerate the corneal tissue reparation. In the process of infecting host, the fungus secretes some specificity enzyme, such as phospholipase and proteinase, degrades and destructs host's ingredient. Then the invasion of fungus becomes more easily. The toxicity of fungus and medicine antiseptic both do harm to the corneal epithelium. Viral infection induces corneal hypesthesia, affects corneal nutrition metabolism and causes postponement of epithelium repair. When the infection was under control, the patients used autologous serum topically besides the anti-fungus treatment. Then the corneal reparation can be accelerated. While during the treatment of viral corneal ulceration, we can add the serum relatively early.3. The longer duration of PED before the initiation of autologous serum, the more time will be used for epithelium recovery. The duration of PED before the initiation of autologous serum in ineffective cases was 46±19.80 d, partially effective cases 27.3±2.52d,and effective cases 17±2.16d.