Abstract
The use of blood-based eye drops as therapy for various diseases of the ocular surface has become increasingly popular in ophthalmic practice during recent years. The rationale for their use is based on the promotion of cellular proliferation and migration thanks to the supply of metabolically active substances, in particular growth factors. Blood-derived eye drops have been used for the treatment of several ocular surface disorders, such as dry eye disease, corneal ulcer, persistent epithelial defect, neurotrophic keratitis, ocular surface burn, recurrent corneal erosion, and limbal stem-cell deficiency. Both autologous (from patients themselves) and heterologous (from adult donors or from cord blood sampled at birth)-derived products exist, and each source has specific pros and cons. Despite an extensive literature, several issues are still under debate and the aim of this manuscript is to review the indications, preparation methods and storage, characterization of content, rationale for clinical outcomes, patient stratification, length of treatment, and rationale for repeated treatments at disease relapse. A rationale based on a “5 Ws and 2 Hs” protocol is proposed as a way of thinking, with the attempt to clarify Who, Why, When, Where, What, and How to use these treatment options.
Highlights
Dry Eye Disease (DED) is “a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles” [1]
Two recent cross-over trials on severe DED reported a higher decrease of symptoms score in the auto-serum eye drops (SED) group compared to the control group treated with tear substitutes [52,53]; a significant improvement of TBUT was reported in the auto-SED group only in the study from Celebi [53]
Yilmaz et al reported a significant magnitude of the mean improvement of symptoms and TBUT in patients with DED due to systemic isotretinoin after auto-SED therapy compared to those treated with tear substitutes [54]
Summary
Dry Eye Disease (DED) is “a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles” [1]. An increasing number of peer-reviewed papers have been published over the last fifteen years, showing the expanded indication for treatment, including mainly DED, persistent epithelial defect (PED), ocular graft-versus-host disease (oGVHD), recurrent corneal erosion (RCE), neurotrophic keratitis (NK), and limbal stem-cell deficiency (LSTD). Despite this extensive literature, there are still several issues under debate related both to the lack of a standardised protocol for preparation and storage and to the absence of consensus on the clinical strategy to achieve the best results, in particular, the rationale for clinical outcomes, patients’ stratification, length of treatment, and the rationale for repeated treatments. The aim of this manuscript is to review the indications, preparation methods, and clinical efficacy of blood-derived products used in ophthalmological practice, with a particular focus on unmet needs, current challenges, and future directions in clinical practice
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