Abstract: Autologous serum (again)

While talking recently with a lady with severe post PRK dry eye who had recently sought (yet) another opinion from a well reputed corneal specialist, I was rather disgusted to hear that the doctor stated flatly that she does not ever use autologous serum because "it doesn't work". Hm. News to me. There has been a plethora of studies about it in the last couple of years - clearly it's helping at least enough people to fill a lot of studies and it does not deserve the big brush-off from ophthalmologists, especially if they have been unable to resolve their patients' symptoms in other ways.

Incidentally, the same doctor professed not to believe that PRK can cause dry eye or that LASIK can cause persistent dry eye. What is wrong with these people? Have they drunk too much pharmaceutical kool-aid, or don't they read their own peers' published studies at least once in awhile?

Autologous serum eye drops for the treatment of dry eye diseases.
Cornea. 2008 Sep;27 Suppl 1:S25-30.

Kojima T, Higuchi A, Goto E, Matsumoto Y, Dogru M, Tsubota K.
Department of Ophthalmology, Social Insurance Chukyo Hospital, Nagoya, Japan. tkojkoj@mac.com

Conventional treatment of dry eye mainly consists of the use of preservative-free artificial eye drops and punctal occlusion. None of the commercially available artificial tear preparations include essential tear components such as epidermal growth factor, hepatocyte growth factor, fibronectin, neurotrophic growth factor, and vitamin A-all of which have been shown to play important roles in the maintenance of a healthy ocular surface epithelial milieu. We reported previously that autologous serum (AS) eye drops contain these essential factors and that AS eye drops are beneficial in the treatment of ocular surface diseases such as persistent epithelial defects, superior limbic keratoconjunctivitis, keratoconjunctivitis sicca, and neurotrophic keratopathy. However, there is some controversy regarding the efficacy of AS treatment. We demonstrated that this modality is more effective than artificial tears in a randomized control study. In in vivo and in vitro experiments, AS eye drops showed marked suppression of apoptosis in the conjunctival and corneal epithelium. Albumin, the major protein in serum, improved ocular surface damage in vivo and rescued apoptosis after serum deprivation in vitro. The biological background of AS eye drops and previous clinical studies of these medications for the treatment of dry eye are discussed.