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Leonhard M, Turner C, Langenbucher A, Flockerzi E, Seitz B. [Comparison of the Effect of Autologous Serum on Therapy Resistant Corneal Erosions and Ulcers on the Corneal Graft vs. the Patient's Own Cornea]. Klin Monbl Augenheilkd 2024; 241:102-109. [PMID: 37164338 DOI: 10.1055/a-2091-0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE The aim of this study is to compare the healing of corneal epithelial defects or ulcers on the corneal graft in comparison with the patient's own cornea after treatment with 100%, undiluted autologous serum eye drops. METHODS In a retrospective study over 7 years, we analysed 263 treatments with autologous serum eye drops of persistent corneal epithelial defects (erosions [88%] vs. ulcers [12%]). We compared the epithelial healing tendency of patients with defects on their own cornea (51.9%) vs. patients who had previously undergone penetrating keratoplasty (48.1%). Complete epithelial healing during the 28 days of treatment was considered as therapeutic success. In addition, the recurrence rate of the epithelial defects after finishing the therapy was analysed. RESULTS 88.2% of the epithelial defects healed during 28 days of therapy. The recurrence rate during follow-up was 5.1%. There was no significant difference with respect to success rate between corneal defects on the patient's own cornea (87.8%) and on the graft (88.6%; p = 0.137). There was a significantly lower success rate for corneal ulcers (74.2%) than for erosions (90.3%; p < 0.001). The recurrence rate of erosions was 4.4%, vs. 4.3% in ulcers during follow-up. CONCLUSION The results of our study suggest that autologous serum eye drops are a non-invasive and safe alternative treatment for persistent corneal epithelial defects - with no significant difference in patients with a defect on their own cornea vs. defects on the corneal graft. The success rate, but not the recurrence rate, is significantly worse in ulcers than in erosions.
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Affiliation(s)
- Marie Leonhard
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg/Saar, Deutschland
| | - Christina Turner
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg/Saar, Deutschland
| | - Achim Langenbucher
- Institut für Experimentelle Ophthalmologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Elias Flockerzi
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg/Saar, Deutschland
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg/Saar, Deutschland
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[Autologous serum eye drops for therapy-resistant epithelial defects of the cornea : Impact of underlying disease and simultaneous amniotic transplantation in 990 applications]. DIE OPHTHALMOLOGIE 2023; 120:43-51. [PMID: 35925344 DOI: 10.1007/s00347-022-01677-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The aim of the study was to evaluate the impact of simultaneous amniotic membrane transplantation (AMT), status of the cornea (own cornea vs. graft) and underlying disease on the success and recurrence rates of autologous serum (AS) in therapy-resistant epithelial defects. PATIENTS AND METHODS Between 2007 and 2019, 990 treatments with AS in 703 eyes of 645 patients were retrospectively examined. The presence of erosion or ulcer, use of AMT, status of the cornea and the underlying disease were recorded. Epithelial closure rate within 4 weeks and the recurrence rate after epithelial closure were main outcome measures. The median observation period was 50 months. RESULTS Epithelial closure was seen in 73.6% and recurrence in 27.4%. AMT was used significantly more often for ulcers (p < 0.001) and recurrences (p = 0.048). Without AMT, there was a significantly higher epithelial closure rate (p < 0.001) and faster healing tendency (p < 0.001). There was no difference between own corneas and grafts with respect to epithelial closure rate (p = 0.47). On the grafts there was a significantly higher recurrence rate (p = 0.004) and faster recurrence (p = 0.03), especially ≤6 months after epithelial closure. The underlying diseases showed a significant difference in epithelial closure rate (p = 0.02) and recurrence rate (p < 0.001) with highest success in corneal dystrophies and lowest in congenital aniridia. CONCLUSION AS is an effective therapeutic option for therapy-resistant epithelial defects. There was a high success rate for the grafts but with a higher tendency to develop recurrences. In cases of simultaneous AMT, a reduced success rate can be expected, due to the higher complexity of the given situation. AS can be used successfully in various underlying diseases, with limitations in case of congenital aniridia.
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Jones L, Downie LE, Korb D, Benitez-del-Castillo JM, Dana R, Deng SX, Dong PN, Geerling G, Hida RY, Liu Y, Seo KY, Tauber J, Wakamatsu TH, Xu J, Wolffsohn JS, Craig JP. TFOS DEWS II Management and Therapy Report. Ocul Surf 2017; 15:575-628. [DOI: 10.1016/j.jtos.2017.05.006] [Citation(s) in RCA: 578] [Impact Index Per Article: 82.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 02/06/2023]
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Tahmaz V, Gehlsen U, Sauerbier L, Holtick U, Engel L, Radojska S, Petrescu-Jipa VM, Scheid C, Hallek M, Gathof B, Cursiefen C, Steven P. Treatment of severe chronic ocular graft-versus-host disease using 100% autologous serum eye drops from a sealed manufacturing system: a retrospective cohort study. Br J Ophthalmol 2016; 101:322-326. [PMID: 27267447 DOI: 10.1136/bjophthalmol-2015-307666] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 04/12/2016] [Accepted: 05/12/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To analyse patients with chronic ocular graft-versus-host disease (GvHD) under treatment with 100% autologous serum eye drops from a sealed manufacturing system. METHODS 17 patients with chronic ocular GvHD received 100% autologous serum eye drops from single use vials manufactured in a sealed system. Retrospective analysis included visual acuity, corneal staining, frequency of artificial tears, ocular symptoms by means of a questionnaire and information on subjective side effects and cost compensation. RESULTS Data of prior to autologous serum eye drops therapy and at a 6-month follow-up were obtained. They demonstrated a significant increase in visual acuity (logMAR oculus dexter/right eye (OD) 0.5±0.32 to 0.4±0.3; oculus sinister/left eye (OS) 0.6±0.35 to 0.3±0.35; p=0.177/0.003) and significant improvement in corneal staining (Oxford grading scheme: OD from 3±1.03 to 2±1.43, OS from 4±1.0 to 2±1.09, p=0.004/0.001) and ocular symptoms (ocular surface disease index: 88±20.59 to 63±22.77; p=0.02). Frequency of artificial tears was reduced and no side effects were reported. Patient satisfaction was 100%, and cost compensation by health insurance reached 80%. CONCLUSIONS 100% autologous serum eye drops using a sealed manufacturing system were efficient in improving the ocular surface, patient symptoms and visual acuity without side effects. It seems to be safe to use 100% autologous serum despite earlier suspicions regarding immune complex accumulations and exacerbation of ocular surface inflammation. The potential effects of serum levels of systemic immunosuppressives through readministration onto the ocular surface need to be elucidated.
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Affiliation(s)
- Volkan Tahmaz
- Department of Ophthalmology, Medical Faculty, University of Cologne, Cologne, Germany.,Competence Center for Ocular GvHD, Medical Faculty, University of Cologne, Cologne, Germany.,Cluster of Excellence: Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Uta Gehlsen
- Department of Ophthalmology, Medical Faculty, University of Cologne, Cologne, Germany.,Competence Center for Ocular GvHD, Medical Faculty, University of Cologne, Cologne, Germany.,Cluster of Excellence: Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Laura Sauerbier
- Department of Ophthalmology, Medical Faculty, University of Cologne, Cologne, Germany.,Competence Center for Ocular GvHD, Medical Faculty, University of Cologne, Cologne, Germany.,Cluster of Excellence: Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Udo Holtick
- Department I of Internal Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Lisa Engel
- Department of Ophthalmology, Medical Faculty, University of Cologne, Cologne, Germany.,Competence Center for Ocular GvHD, Medical Faculty, University of Cologne, Cologne, Germany
| | - Stela Radojska
- Institute of Transfusion Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | | | - Christof Scheid
- Competence Center for Ocular GvHD, Medical Faculty, University of Cologne, Cologne, Germany.,Department I of Internal Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Competence Center for Ocular GvHD, Medical Faculty, University of Cologne, Cologne, Germany.,Cluster of Excellence: Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Department I of Internal Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Birgit Gathof
- Competence Center for Ocular GvHD, Medical Faculty, University of Cologne, Cologne, Germany.,Institute of Transfusion Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, Medical Faculty, University of Cologne, Cologne, Germany.,Competence Center for Ocular GvHD, Medical Faculty, University of Cologne, Cologne, Germany
| | - Philipp Steven
- Department of Ophthalmology, Medical Faculty, University of Cologne, Cologne, Germany.,Competence Center for Ocular GvHD, Medical Faculty, University of Cologne, Cologne, Germany.,Cluster of Excellence: Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
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Abstract
Ocular graft-versus-host disease (GvHD) is predominantly an inflammatory ocular surface disorder after allogeneic hematopoietic stem cell transplantation (HSCT) with increasing incidence. It is not only associated with reduced quality of life because of dry eye syndromes but can also impair visual acuity and lead to blindness due to corneal complications. The GvHD is mostly associated with severe moisturizing disorder of the ocular surface, which is often resistant to therapy and accompanied by chronic inflammation. Corneal complications are an important problem in these patients. An individually adapted multimodal stage-related and interdisciplinary therapy in cooperation with hematologists and oncologists is therefore important for the treatment of patients with ocular GvHD.
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Affiliation(s)
- T Dietrich-Ntoukas
- Klinik für Augenheilkunde, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - P Steven
- Kompetenzzentrum okuläre GvHD, Zentrum für Augenheilkunde, Universität zu Köln, Kerpenerstraße 62, 50937, Köln, Deutschland. .,3 Cellular Stress Responses in Aging-associated Diseases, CECAD, Universität zu Köln, Köln, Deutschland.
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Schargus M, Kohlhaas M, Unterlauft JD. Treatment of Severe Ocular Surface Disorders with Albumin Eye Drops. J Ocul Pharmacol Ther 2015; 31:291-5. [DOI: 10.1089/jop.2014.0161] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marc Schargus
- Department of Ophthalmology, University Eye Hospital, Ruhr University Bochum, Bochum, Germany
- University Eye Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Markus Kohlhaas
- Department of Ophthalmology, St. Johannes Hospital, Dortmund, Germany
| | - Jan Darius Unterlauft
- University Eye Hospital, University of Wuerzburg, Wuerzburg, Germany
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig, Germany
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Spaniol K, Koerschgen L, Sander O, Koegler G, Geerling G. Comparison of application systems for autologous serum eye drops. Curr Eye Res 2014; 39:571-9. [PMID: 24400979 DOI: 10.3109/02713683.2013.855237] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Autologous serum eye drops are used for therapy of severe ocular surface disorders by patients with visual and manual impairments. Until recently, they were prepared under sterile conditions from open blood sampling systems. Closed blood donation systems simplify production. This study compares handling and costs of a new day dosage vial ("Meise-vial") and a single-dose tube system ("Maco-tube") based on closed production systems with conventional dropper bottles. METHODS Nonimpaired volunteers and patients with visual or manual impairment (n = 10 each group) single-handedly tested the applicators filled with 1.5 ml sterile isotonic saline solution. Participants rated convenience of opening the containers and applying eye drops on a scale from 1.0 (very good) to 6.0 (very bad). Number of retrievable drops was counted. Participants were asked which system they prefer, both with and without knowledge of the price for the systems. RESULTS The median for convenience of opening (eye drop application) was 2.0 (1.0) for Meise-vials, 5.0 (4.0) for Maco-tubes, and 2.0 (2.0) for dropper bottles (p < 0.001). Median number of drops retrieved from the systems was 30.5 (vials), 2 (tubes), and 30 (bottles). Ranking did not differ between nonimpaired and impaired participants. Assuming equal prices, 16 participants chose Meise-vials, 14 dropper bottles, and no tubes. With knowledge of pricing, preference changed (p = 0.001), 20 participants (67%) opted for dropper bottles and 5 (17%) preferred the other containers. CONCLUSION Convenience of opening, applying eye drops, and number of drops retrieved was substantially better for dropper bottles and Meise-vials compared with Maco-tubes. Bottles and vials were equally well received. With regard to price, nonimpaired as well as impaired participants preferred dropper bottles. While closed systems simplify production, patients preferred dropper bottles for daily application of autologous serum eye drops for a number of reasons.
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Diagnosis and treatment of ocular chronic graft-versus-host disease: report from the German-Austrian-Swiss Consensus Conference on Clinical Practice in chronic GVHD. Cornea 2012; 31:299-310. [PMID: 22157574 DOI: 10.1097/ico.0b013e318226bf97] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE Ocular chronic graft-versus-host disease (cGVHD) is one of the most frequent long-term complications after hematopoietic stem cell transplantation and is often associated with significant morbidity and reduced quality of life. METHODS The German/Austrian/Swiss Consensus Conference on Clinical Practice in cGVHD aimed to summarize the currently available evidence for diagnosis and (topical) treatment and to summarize different treatment modalities of ocular cGVHD. The presented consensus was based on a review of published evidence and a survey on the current clinical practice including transplant centers from Germany, Austria, and Switzerland. RESULTS Ocular cGVHD often affects the lacrimal glands, the conjunctiva, the lids (including meibomian glands), and the cornea but can also involve other parts of the eye such as the sclera. Up to now, there have been no pathognomonic diagnostic features identified. The main therapeutic aim in the management of ocular cGVHD is the treatment of inflammation and dryness to relieve patients' symptoms and to maintain ocular integrity and function. Therapy should be chosen in the context of the patient's overall condition, systemic immunosuppressive therapy, symptoms, ocular surface integrity, and inflammatory activity. The consensus conference proposed new grading criteria and diagnostic recommendations for general monitoring of patients with graft-versus-host-disease for use in clinical practice. CONCLUSION The evidence levels for diagnosis and treatment of ocular cGVHD are low, and most of the treatment options are based on empirical knowledge. Topical immunosuppression, for example, with cyclosporine, represents a promising strategy to reduce inflammation and dryness in ocular cGVHD. Further clinical trials are necessary to elucidate risk factors for eye manifestation, complications, and visual loss and to evaluate staging criteria and diagnostic and therapeutic measures for ocular cGVHD.
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Abstract
PURPOSE To evaluate the success rate of treating persistent corneal epithelial defects using 50% autologous serum eyedrops. METHODS We reviewed the medical records of all patients seen at our institution from September 2004 to May 2007 who had persistent corneal epithelial defects that were nonresponsive to conventional medical treatment and that were treated with 50% autologous serum eyedrops. We also correlated the defect duration prior to initiation of serum therapy with rate of epithelial healing. RESULTS A total of 25 eyes of 25 patients failed conventional medical therapy for treatment of a persistent corneal epithelial defect and were treated with 50% autologous serum eyedrops every 2 hours while awake. All corneas were neurotrophic, with the etiologies being herpetic (11 eyes), postkeratoplasty (8 eyes), postkeratorefractive surgery (1 eyes), diabetic (1 eye), post-chemical burn (1 eye), and unknown (3 eyes). The median duration of the epithelial defects prior to initiation of autologous serum eyedrops was 13.9 weeks (range 0.29-52 weeks). After institution of autologous serum therapy, 23 of the 25 eyes healed in a mean time of 22.4 days. Seventeen eyes (68.0%) healed within 4 weeks (mean 1.7 weeks) of starting therapy with 50% autologous serum eyedrops. The number of days required for healing was associated with the length of time the defect was open prior to initiation of serum drops (r = 0.68, P < 0.001). CONCLUSIONS The use of 50% autologous serum eyedrops appears to be an efficacious medical treatment modality for persistent corneal epithelial defects that are recalcitrant to conventional medical therapy.
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