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CASE REPORT
Year : 2020  |  Volume : 23  |  Issue : 1  |  Page : 123-125

Rapid healing of a persistent corneal epithelial defect (PCED) with autologous serum treatment


1 Department of Ophthalmology, Private Veni Vidi Eye Health Center, Ankara, Turkey
2 Department of Ophthalmology, Faculty of Medicine, Ufuk University, Ankara, Turkey

Date of Submission26-Mar-2019
Date of Acceptance19-Jul-2019
Date of Web Publication10-Jan-2020

Correspondence Address:
Dr. N Akagun
Private Veni Vidi Eye Health Center, Ankara
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_172_19

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   Abstract 


Autologous serum drop (ASD) is a safe and efficient treatment option for most of the ocular surface diseases. We report a case of a persistent corneal epithelial defect in a patient treated by ASD. A 28 year old male patient presented to our clinic with eye pain and blurry vision in his left eye. Best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/200 in the left eye. Slit lamp examination revealed a central corneal epithelial defect on the left eye and the right eye was normal. Corneal epithelial defect appeared after left upper eyelid chalazion surgery and persisted for 2 months without any response to treatment with eye patching, bandage contact lenses, and artificial eyedrops. We started the treatment with ASD six times daily and preservative-free netilmicin eyedrops four times daily to prevent infection. The drops were used simultaneously with eyepatching for the first two days. The eye was left unpatched after the second day. The corneal epithelial defect resolved after 48 hours. We did not detect a new epithelial defect in the follow up visits. ASD is a quick, safe, and effective treatment option in persistent epithelial defect cases.

Keywords: Autologous serum drop, ocular surface disease, persistent corneal epithelial defect


How to cite this article:
Akagun N, Ozer P A, Gazyagci S. Rapid healing of a persistent corneal epithelial defect (PCED) with autologous serum treatment. Niger J Clin Pract 2020;23:123-5

How to cite this URL:
Akagun N, Ozer P A, Gazyagci S. Rapid healing of a persistent corneal epithelial defect (PCED) with autologous serum treatment. Niger J Clin Pract [serial online] 2020 [cited 2020 Jan 25];23:123-5. Available from: http://www.njcponline.com/text.asp?2020/23/1/123/275612




   Introduction Top


The corneal epithelium is a barrier composed of a linked network of cells. It is the first line of corneal immunological defense.[1] After a corneal trauma, healthy epithelium resurfaces on the wound quickly. Diabetic keratopathy, dry eye syndrome, neurotrophic keratopathy, and epithelial basement membrane dystrophy are some of the risk factors which affect the healing process of cornea. In accordance with the literature, a corneal epithelial defect is a persistent corneal epithelial defect (PCED) when it shows no response to treatment for at least 2 weeks.[1]

The management of PCED can be challenging. The first step of management is treating the underlying condition if possible.[2],[3] Therapies include artificial eyedrops, bandage soft contact lenses, eye patching, punctal occlusion, corneal debridement, tarsorrhaphy, amniotic membrane grafting, ASD, and limbal stem cell transplantation.[4],[5],[6],[7],[8],[9],[10]


   Case Report Top


A 28-year-old male patient presented to our clinic with eye pain and blurry vision in the left eye. BCVA was 20/20 in the right eye and 20/200 in the left eye. Slit-lamp examination showed a central corneal epithelial defect in the left eye and the right eye examinations were determined normally. This corneal epithelial defect appeared after left upper eyelid chalazion surgery and was reported to persist for the last 2 months without any response to any treatment with eye patching, bandage contact lenses, and artificial eyedrops.

After this 2 months period, the patient presented to our clinic and we started the treatment with ASD six times daily and netilmicin preservative-free eyedrop four times daily to prevent infection. The eyedrop was applied simultaneously with patching for the first two days. The eye was left unpatched after the second day. The corneal epithelial defect resolved after 48 hours but slight punctate keratopathy remained. BCVA was 20/20 in both eyes. The patient did not complain about blurry vision, discharge, and pain. We stopped netilmycin eyedrop and continued the ASD four times daily for one month. After one month of ASDs therapy, punctate keratopathy also disappeared.


   Discussion Top


The ASD and tear content are very similar.[11] Epithelial growth factor (EGF), transforming growth factor (TGF)–beta, and vitamin E have an accelerating effect on epithelialization. On the other hand, IgG and lysozyme have antibacterial effects.[12]

When ASD is being prepared, approximately 200 ml of whole blood is collected by phlebotomy and then allowed to coagulate at room temperature for 2 hours in a vertical position. The coagulated blood is then centrifuged at 3000 rpm for 15 min and the supernatant is removed from the precipitate in sterile conditions.[11] The serum is diluted with carboxymethyl cellulose to 20% concentration. It can be kept at +4°C for 1 month and in the freezer for 3 months at −20°C in a closed form.

The main indications for the use of ASD are dry eye syndrome, cases of PCED, punctate epithelial erosions, filamentous keratitis, neurotrophic ulcers, and recurrent corneal epithelial defects. ASD can also be used with contact lenses.

There have been no reports of serious complications because of the use of ASD. Due to high-protein content, there is a risk of contamination in ASD. If there is a high risk of infection, antibiotic therapy should be started with ASD.


   Conclusion Top


ASD is an effective and easy treatment option when there is no response to lubricants, bandage contact lenses, and eye patching treatment in PCED cases.[13] Significant healing is achieved in the symptoms in a very short period. Patients undergoing ASD treatment should be closely monitored to avoid contamination and secondary infection.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Hayashi Y, Toshida H, Matsuzaki Y, Matsui A, Ohta T. Persistent corneal epithelial defect responding to rebamipide ophthalmic solution in a patient with diabetes. Int Med Case Rep J 2016;9:113-6.  Back to cited text no. 1
    
2.
Dilan Y, Gamze M, Serap YO, Mehmet EK, Mustafa NE. Autologous serum treatment in dry eye syndrome: A case report. JOJ Case Stud 2018;8:555741.  Back to cited text no. 2
    
3.
Campanile TM, St Clair DA, Benaim M. The evaluation of eyepatching in the treatment of traumatic corneal epithelial defects. J Emerg Med 1997;15:769-74.  Back to cited text no. 3
    
4.
Tsubota K, Goto E, Shimmura S, Shimazaki J. Treatment of persistent corneal epithelial defect by autologous serum application. Ophthalmology 1999;106:1984-9.  Back to cited text no. 4
    
5.
Young AL, Cheng AC, Ng HK, Cheng LL, Leung GY, Lamm DS. The use of autologous serum in persistent corneal epithelial defects. Eye (Lond) 2004;18:609-14.  Back to cited text no. 5
    
6.
Poon AC, Geerling G, Dart JK, Fraenkel GE, Daniels JT. Autologous serum eye drops for dry eye and epithelial defects: Clinical andin vitro toxicity studies. Br J Ophthalmol 2001;85:1188-97.  Back to cited text no. 6
    
7.
Schrader S, Wedel T, Moll R, Geerling G. Combination of serum eye drops with hydrogel bandage contact lenses in the treatment of persistent epithelial defects. Graefe's Arch Clin Exp Ophthalmol 2006;244:1345-9.  Back to cited text no. 7
    
8.
Versura P, Profazio V, Buzzi M, Stancari A, Arpinati M, Malavolta N, et al. Efficacy of standardized and quality controlled cord blood serum eye drop therapy in the healing of severe corneal epithelial damage in dry eye. Cornea 2013;32:412-8.  Back to cited text no. 8
    
9.
Vajpayee RB, Mukerji N, Tandon R, Sharma N, Pandey RM, Biswas NR, et al. Evaluation of umbilical cord serum therapy for persistent corneal epithelial defects. Br J Ophthalmol 2003;87:1312-6.  Back to cited text no. 9
    
10.
Kim KM, Shin YT, Kim HK. Effect of autologous platelet rich plasma on persistent corneal epithelial defect after infectious keratitis. Japanese J Ophthalmol 2012;56:54.  Back to cited text no. 10
    
11.
Liu L, Hartwig D, Harloff S, Herminghaus P, Wedel T, Geerling G. An Optimized protocol for the production of autologous serum eye drops. Graefe's Arch Clin Exp Ophthalmol 2005;243:706-14.  Back to cited text no. 11
    
12.
Akagun N, Tekcan H. The efficacy and safety of autologous serum in the treatment of ocular surface disease. Haydarpaşa Numune Eǧitim ve Araştırma Hastanesi Tıp Dergisi 2014;:117-24.  Back to cited text no. 12
    
13.
Noble BA, Loh RSK, Mac Lennan S, Pesudovs K, Reynolds A, Bridges LR, et al. Comparison of autologous serum eye drops with conventional therapy in a randomized controlled crossover trial for ocular surface disease. Br J Ophthalmol 2004;88:647-52.  Back to cited text no. 13
    




 

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   Case Report
   Discussion
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