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Autologous serum eye drops for ocular surface disorders

¹ Department of Ophthalmology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
² National Blood Service, Leeds Centre, Bridle Path, Leeds LS15 7TW, UK
³ Institute of Immunology and Transfusion Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany

Correspondence to:
Correspondence to:
Gerd Geerling
Department of Ophthalmology, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck; Germany; ggeerling{at}ophtha.mu-luebeck.de

Tears have antimicrobial, nourishing, mechanical, and optical properties. They contain components such as growth factors, fibronectin, and vitamins to support proliferation, migration, and differentiation of the corneal and conjunctival epithelium. A lack of these epitheliotrophic factors—for example, in dry eye, can result in severe ocular surface disorders such as persistent epithelial defects. Recently, the use of autologous serum in the form of eye drops has been reported as a new treatment for severe ocular surface disorders. Serum eye drops may be produced as an unpreserved blood preparation. They are by nature non-allergenic and their biomechanical and biochemical properties are similar to normal tears. In vitro cell culture experiments showed that corneal epithelial cell morphology and function are better maintained by serum than by pharmaceutical tear substitutes. Clinical cohort studies have reported its successful use for severe dry eyes and persistent epithelial defects. However, the protocols to prepare and use autologous serum eye drops varied considerably between the studies. As this can result in different biochemical properties protocol variations may also influence the epitheliotrophic effect of the product. Before the definitive role of serum eye drops in the management of severe ocular surface disease can be established in a large randomised controlled trial this has to be evaluated in more detail. In view of legislative restrictions and based upon the literature reviewed here a preliminary standard operating procedure for the manufacture of serum eye drops is proposed.

Abbreviations: BSS, balanced salt solution; EGF, epidermal growth factor; GvHD, graft versus host disease; Hb, haemoglobin; HBV, hepatitis B virus; HCV, hepatitis C virus; HTLV, human T cell lymphoma virus; KCS, keratoconjunctivitis sicca; OSD, ocular surface disease; PED, persistent epithelial defect; RES, recurrent erosion syndrome; rpm, rounds per minute; SLK, superior limbal keratoconjunctivitis; SOP, standard operating procedures; TGF-ß, transforming growth factor beta

Keywords: serum; blood products; ocular surface; dry eye; persistent epithelial defect; regulatory restrictions

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