Abstract
To assess the impact of autologous serum eye drops on the level of ocular surface apoptosis in patients with bilateral severe dry eye disease. This prospective study was conducted on 10 patients with severe dry eye due to graft versus host disease (group 1) and 6 patients with severe dry eye due to primary Sjögren's syndrome (group 2). Impression cytology specimens from the bulbar conjunctiva were obtained before and after a three-month treatment with 20% autologous serum eye drops applied a maximum of 12 times a day together with regular therapy with artificial tears. The percentage of apoptotic epithelial cells was evaluated immunochemically using anti-active caspase 3 antibody. In group 1, the mean percentage of apoptotic cells was 3.6% before the treatment. The three-month treatment led to a significant decrease to a mean percentage of 1.8% (P = 0.028). The mean percentage of apoptotic conjunctival cells decreased from 5.4% before the treatment to 3.8% in group 2; however, these results did not reach the level of significance. Three-month autologous serum treatment led to the improvement of ocular surface apoptosis, especially in the group of patients with severe dry eye due to graft versus host disease. This result supports the very positive effect of autologous serum on the ocular surface in patients suffering from severe dry eye.
Highlights
Dry eye disease (DED) is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability[1]
After the three-month treatment, the mean percentage of these cells increased from 86 ± 21 to 91 ± 11%
In 31% (5 patients), the percentage was lower than 5%; 5% was exceeded by one patient from group 1 and by three patients from group 2
Summary
Dry eye disease (DED) is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability[1]. The etiology of DED involves multiple factors, including chronic graft versus host disease (GvHD) and primary Sjögren’s syndrome. The immune system of the graft recognizes the recipient and attacks the host cells. Sjögren’s syndrome is a chronic autoimmune disease in which the immune system attacks especially the salivary and lacrimal glands. High levels of pro-inflammatory chemokines have been detected in the tears and on the ocular surface of the conjunctiva in both GVHD and Sjögren’s syndrome patients[2]. The release of pro-inflammatory mediators may lead to ocular surface damage as well as to lacrimal epithelial cell dysfunction and apoptosis[3,4]
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