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A novel approach to treatment of non-healing corneal epithelial defects and dry eyes with self administration of finger prick autologous whole blood (FAB method)

Poster Details

First Author: J.Wawrzynski UK

Co Author(s):    A. Sharma   D. Armstrong   J. Moore        

Abstract Details



Purpose:

Dry eye syndrome and chronic corneal epithelial defects that are resistant to standard medical therapy often require surgical management such as tarsorrhaphy, botulinum toxin induced ptosis or keratoplasty. Autologous serum eye drops have been found in controlled trials to be beneficial for patients with severe dry eyes and chronic corneal epithelial defects, improving the ocular surface and reducing symptoms. This is likely to be due to the presence of growth factors in the serum. However, there are several logistical and financial difficulties with using autologous serum. Obtaining autologous serum drops requires frequent venesection, which is contraindicated in some patients. The production of autologous serum is an expensive process that is not available as standard on the NHS. Obtaining funding can take several weeks to months if it is at all granted. There is a risk of ocular perforation whilst waiting for funding. The serum must be stored by the patient in the fridge in hundreds of separate bottles. In this study, we investigate whether fresh autologous blood (FAB) obtained by pricking the finger is a safe and effective alternative to autologous serum in the treatment of dry eyes and chronic corneal epithelial defects.

Setting:

Mater Hospital Belfast Moorfields Eye Hospital

Methods:

Four patients with persistent corneal epithelial defects resistant to full conventional medical therapy (including steroids and lubricants drops) were recruited. One ulcer was due to chemical trauma and the other three cases were secondary to herpes simplex neurotrophic ulceration. Two further patients with dry eyes secondary to Sjogren's syndrome were recruited. Both were resistant to full conventional medical therapy. Ocular examination including ulcer measurement and photograph documenting epithelial defect or dry eye staiing were carried out. Each patient continued with maximal medical therapy and also applied autologous blood to their affected eye(s) four times per day according to the following technique: A fingertip was wiped with an alcohol steret and self-pricked using a standard diabetic lancet. A drop of blood was produced and applied to the lower fornix of the affected eye with the lower lid pulled down slightly. Study design: Non-controlled prospective interventional case series.

Results:

Corneal Ulcers All four patients showed improved corneal epithelial healing within one week. All demonstrated complete healing within two weeks of commencing FAB therapy. There was a recurrence of an epithelial defect in one patient with herpetic neurotrophic ulceration following a period of initial re-epithelialisation: This was a case of dense neurotrophia which re-responded positively to increased use of autologous blood. Currently maintenance treatment of six times per day is required to maintain the epithelial surface and the patient has been on FAB therapy for approximately 30 months. Dry Eyes Both patients showed substantial improvement on both clinical examination and self-reported ocular comfort within two weeks. One dry eye patient symptoms and signs improved significantly after 6 weeks and the second case improved within 2 weeks. The first case had been on maximal medical treatment including topical cyclosporine for 3 years and the second case stated it was the most ‘soothing drop' they have ever had straight away. Patients tolerated the treatment well and no patients suffered any adverse events.

Conclusions:

This observational study provides evidence that suggests the use of FAB is a practicable, safe and effective treatment for persistent corneal epithelial defects and dry eyes due to Sjogrens syndrome. Patients on FAB treatment were found to have improved appearance of the ulcer/ dry eye on clinical examination and better ocular comfort on the OCI questionnaire within one or two weeks of commencing therapy. The results from this case series suggest that FAB is superior to maximal medical therapy and has a similar effect to autologous serum without suffering from the significant drawbacks that autologous serum necessarily brings with it. In contrast to autologous serum, all patients were able to start treatment immediately as soon as required as no application for funding is necessary. FAB treatment is inexpensive as it does not require the use of a blood bank to purify serum from whole blood and is entirely self-administered. Patients tolerated the treatment well and were able to carry out the treatment independently after initial tuition. This proof of concept study has resulted in the development of a robust protocol for subsequent recruitment of patients into a multicentre case control study to generate statistical evidence of the potential benefit. FINANCIAL INTEREST: NONE

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