Autologous serum drops relieve dry eye over long term

Autologous serum contains growth factors and anti-inflammatory mediators for patient relief.

Issue: January 25, 2015

Patients with dry eye disease who continue to have problems when standard treatment regimens do not work may feel relief using autologous serum drops, according to one researcher.

“We choose to use autologous serum tears only in patients who have failed most other therapies, such as lubricating eye drops, Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan), punctal plugs and topical steroids,” Shahzad I. Mian, MD, told Ocular Surgery News.

A number of published reports over the years, though, indicate that autologous serum drops can benefit patients with severe dry eye or other ocular surface diseases in general, according to Mian, the co-author of a retrospective study of long-term use of 50% concentration of autologous serum drops in 63 patients with dry eye disease.

Mian said that he and colleagues have used the 50% concentration since 2008, raising the concentration from 20% because patients were not achieving significant relief. Results are better, he said, but he and colleagues are not pursuing a greater concentration, in part because increased viscosity can increase blurriness.

Study design, results

Study patients instilled one drop of the 50% autologous serum about four times daily. The mean follow-up was 12 months, with up to 4 years for some patients.

“We found a significant improvement at various time points for a variety of dry eye disease parameters, including the corneal fluorescein staining and Schirmer’s test scores for aqueous tear production,” Mian said.

Subjective symptoms as described by patients in the Ocular Surface Disease Index also dramatically improved.

“These results are overall better than we anticipated,” Mian said, noting that, in general, study patients received the maximum benefit from autologous serum drops at roughly 12 months.

“Autologous serum drops definitely provide relief beyond 12 months, but we lost patients to follow-up,” he said. No complications from the drops were observed in any patient.

Nearly 20% of study patients had dry eye disease associated with graft-versus-host disease.

“These patients have also benefited from serum eye drops,” Mian said, as did the 33% of study patients who concurrently used a prosthetic replacement of the ocular surface ecosystem (BostonSight PROSE).

Autologous serum is considered effective for treating dry eye because growth factors and anti-inflammatory mediators provide comfort to the patient, Mian said, but many patients continue to use lubricating eye drops and less often use topical corticosteroid drops.

Creating serum

To provide autologous serum eye drops to patients, a clinician needs to contract a simple phlebotomy service for drawing blood. A centrifuge is also required to spin the blood.

“We work with a compounding pharmacy in our area that draws the serum from the centrifuge blood sterilely under a hood and dilutes it to the concentration recommended, then places it in vials for the patient,” Mian said.

Blood is drawn from patients on average once every 3 months, and one refrigerated vial is dispensed weekly.

“We warn patients that if a vial becomes contaminated, they are at risk for infection; however, we have yet to encounter any infections,” Mian said.

Cost is a concern for patients, in that autologous serum drops, including the blood draw, are an out-of-pocket expense that costs about $220 for a 3-month supply at Mian’s practice.

Although Mian has no experience with allogeneic serum, the literature shows this is a potential alternative. – by Bob Kronemyer

Reference:

Hussain M, et al. Cornea. 2014;doi:10.1097/ICO.0000000000000271.

For more information:

Shahzad I. Mian, MD, can be reached at Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, 1000 Wall St., Ann Arbor, MI 48105; 734-615-5476; email: smian@umich.edu.
Disclosure: Mian has no relevant financial disclosures.