Autologous serum therapy in recalcitrant laser-assisted in situ keratomileusis-induced neurotrophic epitheliopathy

Abstract

Background/Purpose:To evaluate the efficacy of autologous serum eye drops for patients with recalcitrant laser-assisted in situ keratomileusis (LASIK)-induced neurotrophic epitheliopathy (LINE) unresponsive to conventional treatment, and to determine the possible predisposing risk factors of these patients.Methods:We enrolled 10 consecutive patients (20 eyes) undergoing femtosecond-assisted myopic LASIK surgery presenting with recalcitrant LINE for > 1 year. Another 340 patients (713 eyes) receiving femtosecond-assisted myopic LASIK without recalcitrant LINE were set as controls. Possible risk factors associated with recalcitrant LINE were investigated. Twenty percent autologous serum treatment was prescribed to 20 eyes. The efficacy of autologous serum was assessed with ocular surface conditions, tear function, and the change of best-corrected visual acuity.Results:Age older than 30 years [odds ratio (OR) = 7.74; 95% confidence interval (CI), 1.74–34.50], flap thickness < 110 μm (OR = 3.47; 95% CI, 1.22–9.73), and a flap diameter < 8.5 mm (OR = 5.38; 95% CI, 1.95–14.85) pose higher risks in femtosecond laser-assisted myopic LASIK. All eyes (100%) achieved remission after autologous serum treatment. The visual acuity before treatment was 0.49 ± 0.41 in LogMAR, and the visual acuity after treatment was 0.14 ± 0.22 in LogMAR. Time to achieve remission was 8.26 ± 11.87 weeks. Mean relapse-free survival after discontinuing autologous serum was 47 weeks.Conclusion:Risk factors of recalcitrant LINE in femtosecond laser-assisted myopic LASIK were identified as older age, a thinner flap (<110 μm), and a small flap diameter (<8.5 mm). Autologous serum eye drops can effectively improve corneal surface conditions and postoperative visual acuity.

Central toxic keratopathy after small incision lenticule extraction surgery:A case report

“…It has been reported that autologous serum drops have beneficial effects on corneal opacities after LASIK and PRK. 12 Autologous serum harbors essential elements in the ocular surface, such as components maintaining healthy epithelium, including epidermal growth factor, 13,14 matrix metalloproteinase inhibitors, and anti-inflammatory factors in the autologous serum, which can promote a greater epithelial healing rate. 12,13 Regarding CTK, few studies have postulated that the specific etiology is associated with inflammatory cytokines, metalloproteinases, and antibody-antigen immune responses.…”

“…12 Autologous serum harbors essential elements in the ocular surface, such as components maintaining healthy epithelium, including epidermal growth factor, 13,14 matrix metalloproteinase inhibitors, and anti-inflammatory factors in the autologous serum, which can promote a greater epithelial healing rate. 12,13 Regarding CTK, few studies have postulated that the specific etiology is associated with inflammatory cytokines, metalloproteinases, and antibody-antigen immune responses. 6 Hence, prescribed prednisolone acetate supplemented with autologous serum eyedrops is considered the treatment regime.…”

Refractive surgery and dry eye - An update

“…[ 96 ] Recalcitrant cases of LASIK-induced neurotrophic epitheliopathy have been found to benefit from autologous serum therapy with significant improvement in ocular surface parameters and visual acuity. [ 98 ] Platelet-rich plasma (PRP) and plasma rich in growth factors (PRGF) are considered to have advantages over autologous serum due to a higher concentration of growth factors, anti-inflammatory cytokines, and other platelet derivatives. [ 99 ] Autologous PRGF and PRP have been found to be efficacious in improving persistent dry eye symptoms and corneal staining in post-LASIK patients unresponsive to conventional therapy.…”

Latest advances in the treatment of corneal diseases

“…In Lin et al's study, all cases of neurotrophic epitheliopathy were healed using conventional autologous serum preparation after LASIK surgery. 2 In Wu et al's study, three patients with neurotrophic ulcer, exposure corneal ulcer and limbal deficiency with corneal ulcer after HSV keratitis respectively were healed successfully with platelet-rich plasma. 3 Both studies indicate the importance of neurotrophic factors in the treatment of neurotrophic epitheliopathy and stromal defects caused by impairment of trigeminal innervation leading to corneal epithelial breakdown, impairment of healing, and development of corneal ulceration, melting, and perforation.…”

“…Neurotrophic factors are important factors associated with epithelialization and stromal wound healing after corneal injury. 1 In this issue of the Taiwan Journal of Ophthalmology , Lin et al 2 and Wu et al 3 present two autologous preparations from blood, autose-rum and autologous platelet-rich plasma to treat recalcitrant LASIK-induced neurotrophic epitheliopathy and refractory corneal defects respectively. In Lin et al's study, all cases of neurotrophic epitheliopathy were healed using conventional autologous serum preparation after LASIK surgery.…”