Clinical Outcomes of Autologous Serum Eye Drops in Treating Corneal Ulceration in a Domestic Cat: A Case Base Study

BackgroundNowadays, autologous serum eye drops are used in a lot of corneal epithelium pathologies. Their action is based on the high concentration of vitamins, nutrients, and other substances that improve...

Toxic epidermal necrolysis (TEN) is a rare, life-threatening, drug-induced, mucocutaneous disease, which can severely affect the ocular surface. The purpose of this study was to investigate the efficacy of plasmapheresis, human IV immunoglobulins (IVIg), and autologous serum (AS) eyedrops in the treatment of the severe acute ocular complications of TEN. A retrospective chart review of all patients admitted to the Burn Unit, Azienda Ospedaliero-Universitaria-Sassari, Sassari, Italy, from 2009 to 2015, identified 9 patients (2 men, 7 women; mean age 63.8 ± 24.7 years) with TEN. Bilateral, acute ocular surface complications were observed in 7 (78%) patients; 3 showed catarrhal conjunctivitis, whereas 4 had severe pseudomembranous conjunctivitis and corneal ulcers. All patients with TEN were immediately treated with plasmapheresis and human IVIg, which produced a marked improvement in the patients' general condition. In the 3 with catarrhal conjunctivitis, preservative-free artificial tears and topical antibiotics were beneficial. In the 4 with severe pseudomembranous conjunctivitis and corneal ulcers, treatment with AS eyedrops resulted in corneal and conjunctival epithelium healing over 3-6 weeks. After a minimum follow-up of at least 12 months, there were minimal/mild residual signs and symptoms of dry eye. Plasmapheresis and IVIg may be life-saving and contribute to reduce ocular surface inflammation in TEN. Autologous serum eyedrops, prepared after plasmapheresis completion and IVIg infusion, may be helpful in the management of the severe acute ocular complications of TEN.

<p style="text-align: justify;"><strong>Objectives: </strong>To study the current practice patterns and opinions in the treatment of corneal bacterial ulcers among Saudi ophthalmologists. <strong>Methods:</strong> A web-based online survey was conducted in Saudi Arabia to randomly selected ophthalmologists who were registered with Saudi commission for health specialties during the study period between August 2018 to December 2018 using a structured self-administered questionnaire. <strong>Results:</strong> Of the respondents, general ophthalmologists were 32 (58.2%) and cornea specialists were 23 (41.8%). The mean years of practice was 6.6&plusmn;6.1 [mean&plusmn;SD]. Among the respondents 53 (96.4%) treated corneal ulcer cases, most of them 51 (92.7%) agreed there is a relation between the use of contact lenses and ocular ulcers. Fifty respondents indicated that they prescribed antibiotics for the treatment of corneal ulcer. About 12 (52.2%) of the cornea specialist and 22 (68.8%) of general ophthalmologists prefer to use culture of ulcer (Scrapping and gram staining of ulcer) diagnostic tests prior to treatment of corneal ulcers. Fortified antibiotic used was given higher advantage and the management of ocular ulcers differed according to the severity of each case. <strong>Conclusion: </strong>In conclusion, results found that the management of corneal ulcers varies from specialist to general ophthalmologist. All the respondents agreed that they prescribed two broad spectrum antibiotics to treat an advanced corneal ulcer. Additionally, most of the respondents believed that fourth generation fluoroquinolones were less effective in comparison to fortified, broad-spectrum antibiotics. <p style="text-align: justify;"><strong> Key words:</strong> Corneal bacterial ulcers, Antibiotics, Fluoroquinolones, Broad spectrum antibiotics, Fortified antibiotics.

Background: When left untreated, corneal ulcers can progress unfavorably, posing a risk to the vision of an animal. The application of cyanoacrylate adhesive offers an alternative for treating deep ulcers without the need for surgical intervention that requires using sutures on the cornea. This adhesive not only has antibacterial properties but also demonstrates antifungal efficacy. Moreover, it is easily accessible and cost-effective, making it a promising solution. The objective is to report a case of deep corneal ulcers in a cat successfully treated with n-butyl-2-cyanoacrylate adhesive. Case: A 4-month-old male Persian cat had been experiencing ocular discomfort and tearing for 7 days. There was no reported history of previous ocular trauma, and no treatment had been administered. Examination of the right eye revealed severe blepharospasm, photophobia, epiphora, conjunctival hyperaemia, chemosis, miosis and mucopurulent ocular discharge. Pupillary light reflexes, including direct, consensual and dazzle reflexes, were tested with a light source and were within normal limits, with preserved vision. No abnormalities were observed in the left eye. Using a portable slit lamp, 5 deep stromal corneal ulcers were observed in the right eye, along with mild diffuse corneal edema. Fluorescein staining was performed, and the dye impregnated all corneal ulcers. All ulcers were less than 3 mm in diameter. During the same consultation, the application of n-butyl-2-cyanoacrylate adhesive (Hystoacryl®) at the lesion sites and covering with the third eyelid were indicated. The epithelium near the lesions was debrided with a scalpel blade, and the lesion sites were dried with cellulose sponges before applying cyanoacrylate adhesive using an insulin syringe and needle. All corneal ulcers were covered with the adhesive. After 1 min, the adhesive was polymerised using Ringer's lactate solution applied with a 3 mL syringe. Tobramycin 0.3% eye drops [every 4 h for 15 days] and sodium flurbiprofen-based eye drops [every 4 h for 15 days] were prescribed. In addition, 1% atropine sulphate ophthalmic ointment was prescribed [SID for 5 days]. To prevent self-trauma, the use of an Elizabethan collar was recommended for 15 days. Weekly evaluations were conducted. Twenty-one days after the procedure, intense corneal opacity and granulation tissue were observed at the lesion sites. The fluorescein staining test was negative. Thirty days after the procedure, remission of granulation tissue and decreased corneal neovascularization were observed, and finally, after 6 months, only mild opacity was present in the area where the adhesive had been applied, and the remaining cornea stayed transparent. The patient had visual function. Discussion: The advantages of cyanoacrylate adhesives include short surgical time, bacteriostatic activity against gram-positive bacteria, inhibition of inflammatory cell migration and collagenase formation, low cost, easy and rapid polymerization and the absence of the need for sutures. Despite the widespread use of cyanoacrylate adhesive in human ophthalmology, its application in animals is still limited, with few documented and reported clinical cases. Compared to other methods employed for the surgical treatment of corneal ulcers, cyanoacrylate adhesive offers several advantages, such as easy and quick application and not requiring sutures in the cornea. In this case, all the ulcers were up to 3 mm in diameter each, and the treatment of them was successful. Besides maintaining the integrity of the eyeball, the adhesive served as a support for healing. The patient maintained visual function with a transparent cornea. Keywords: cat, ophthalmology, cyanoacrylate adhesive.

Comparison of Autologous Serum and Umbilical Cord Serum Eye Drops for Dry Eye Syndrome

Introduction: Autologous serum eye drops (ASED) are used in the treatment of most severe stages of dry eye. Once introduced, it is currently considered impossible to return to other lubricating eye drops or other commercially available therapeutic regimen. Materials and Methods: In a randomized study, non-preserved high-molecular-weight hyaluronic acid eye drops were offered as an alternative to 11 patients using autologous serum treatment for at least 3 months. The control group (n = 5) continued their treatment with ASED. The verum group (n = 6) used very-high-molecular-weight hyaluronic eye drops (Comfort Shield®) instead of the ASED. Results: From four of initially six patients in the verum group that finished the study, 2 (50%) preferred to stay with the very-high-molecular-weight hyaluronic acid eye drops beyond the trial period, the other two returned to the earlier therapy with ASED. The control group continued their treatment as before and finished the study after 8 weeks. Conclusion: For the first time, artificial eye drops, i.e., high-molecular-weight hyaluronic acid eye drops, offered an acceptable alternative to ASED. Some patients perceived these drops as even better than the patient’s own serum. This is the first evidence that optimization of the molecular structure of hyaluronic acid can be used to create eye drops that are perceived to be better than other tested tear substitutes and even patients’ own serum. This offers a new treatment perspective for patients with very severe dry eye disease.

Background: Corneal ulcers are frequently reported in the literature in several species, however, the treatment of traumatic lesions on the corneal surface of ruminants is still poorly described. The use of the third eyelid flap is questioned when applied to deep ulcers, since the technique prevents the evolutionary follow-up of corneal healing and compromises care. However, several authors report its successful use for the treatment of superficial and deep corneal ulcers. This technique protects the ocular surface and prevents the occurrence of new lesions or their aggravation. The aim of this study was to report the treatment of corneal ulcers in sheep through the third eyelid flap associated with the use of topical antibiotics.Case: A 2-year-old Dorper sheep, with ocular discomfort, conjunctival hyperemia and mucopurulent secretion in the left eye, was assisted in a private rural property in the West region of Bahia, Brazil. The owner reported that before seeking veterinary help he used a spray based on oxytetracycline and hydrocortisone, which worsened the animal's condition. Upon inspection, it was observed eyelid asymmetry, slight lateralization of the head to the left, periorbital alopecia on the left face, intense blepharospasm in the left eye, with projection of the third eyelid occurring at times. The ophthalmic examination was performed after application of anesthetic eye drops based on proxymetacaine to reduce eye discomfort. A corneal stromal lesion, edema and fibrovascular tissue in the left eye were identified, but the cause of the lesion was not defined, with lagophthalmia, entropion, dystychiasis or ectopic cilia being ruled out. So, it was suggested that the lesion had occurred by a foreign body, such as dust or feed fiber. The contralateral eye showed no changes, Schirmer 15 mm, no changes in sensory and sensory reflexes and negative fluorescein. No signal clinical disease. Due to the severity of the lesion, it was performed a third eyelid flap associated with drug treatment with ciprofloxacin eye drops, every 8 h for 21 days. The animal was placed in the right lateral decubitus position and palpebral akinesia was achieved with the application of 2 mL lidocaine without vasoconstrictor in the region of the auriculopalpebral nerve. This was followed by the routine performance of the third eyelid flap.Discussion: The delay in seeking veterinary care and the application of spray based on oxytetracycline and hydrocortisone aggravated the lesion, since the corticosteroid delays corneal healing and favors the aggravation of the lesion. After desensitization of the cornea, the animal allowed eye manipulation and it was possible to observe the lesion and choose the best treatment, with option for the third eyelid flap because it is a simple and fast technique, does not require special equipment or materials, ideal for performed in the field and is widely used in the treatment of injuries involving the cornea and, besides that, helps to contain corneal perforation and protect the ocular surface. Corneal debridement was also performed to remove necrotic debris and improve drug action, in addition to using broad-spectrum antibiotic eye drops until complete regeneration of the lesion. Twenty-one days after the surgical procedure, the patient had no ocular discomfort, the flap was removed and no changes in the corneal surface were observed. The treatment was considered satisfactory for the healing of the corneal ulcer, guaranteed the esthetics and visual function of the sheep.Keywords: keratitis, surgery, ciprofloxacin, ocular, ruminant.

ABSTRACTBackground: The eye is an important sense organ responsible for sight. The cornea is the outermost of many eye layers, being predisposed to several lesions, some of them being frequent in small animal clinics meanwhile others are unusual and seldom reported in specialized literature. The stroma abscess is a common condition in horses, but atypical in dogs, it's a condition in which a microperforation in the corneal epithelium allows microorganisms or a foreign body to penetrate the corneal stroma, and those become inside the cornea after a re-epithelialization, producing an intense inflammatory response. Therefore, this case reports a case of deep stromal abscess in a Shih Tzu dog.Case: A 4-year-old female Shih Tzu, weighing 4.6 kg, was submitted to ophthalmic examination in which the left eye presented an opaque yellowish-white protruding structure located on the right side, in the center of the cornea (3 o´clock position), bulbar and palpebral conjunctival hyperemia and congestion, chemosis, blepharospasm, and a moderate amount of mucous discharge. The clinical diagnosis was stromal abscess with reflex uveitis. A differential diagnosis should include conditions affecting the anterior part of the cornea, such as an epithelial inclusion cyst and a corneal ulcer. The inclusion cyst, contrarily to the corneal abscess, doesn't cause pain, meanwhile, the corneal ulcer was ruled out by the Fluorescein Staining Test. The recommended treatment was surgical, through lamellar keratectomy, followed by overlapping pedicled conjunctival graft and third eyelid flap. In association with the surgical treatment, oral antibiotics, anti-inflammatory, and opioids, plus topical antibiotics and autologous serum eye drop. Seventy days post-surgery, the previously observed inflammatory signs were no longer present. In the conjunctival graft insertion site perpetuated a scar leucoma with few blood vessels. The therapy was proven effective in solving the stromal abscess and in visual maintenance. Despite the located opacity due to leucoma, it barely causes any impairment, once its lateral position won't impact the central vision, which is more important to predator species than the peripheral vision.Discussion: Stromal abscess is a pathological condition in which an initial perforating corneal injury leads to a rupture of the epithelial barrier, allowing the access of bacterial, fungus, or foreign bodies of organic nature. The morbidity is more frequent in horses, but this report shows that although uncommon, stromal abscesses can occur in dogs. The diagnosis was achieved by an analysis of the clinical history and findings. Conditions that affect the anterior cornea must be among differential diagnoses. Treatment aims for the removal of infectious material with debridement and curetting of the stroma, by performing the lamellar keratoplasty technique, which produces a corneal wound. The implementation of a pedicled conjunctival graft allows, the influx of growth factors, active replication of stromal collagen by fibroblasts, and direct arrival of antibiotics through the blood supply to the exposed portion of the cornea. The third eyelid flap is questioned by some authors, once it complicates the post-op follow up, and hinder the topical therapy from directly reaching the eye surface. Autologous serum: A blood-derived product often used to control corneal melting. The Federal Medicine Board determined that autologous serum eyedrops therapy has been scientifically proven effective, being used worldwide in the treatment of severe eye surface conditions. In Veterinary, studies also demonstrated that autologous serum can improve improve the corneal re-epithelialization in dogs. Keywords: autologous serum, keratectomy, ophthalmology, veterinary.Título: Abscesso estromal em córnea de cãoDescritores: soro autólogo, ceratectomia, oftalmologia, veterinária.

Plasma rich in growth factors (PRGF) eye drops stimulates scarless regeneration compared to autologous serum in the ocular surface stromal fibroblasts

To evaluate the risk and safety profile of autologous serum eye drop therapy in clinical routine over a period of 5 years. This retrospective study involved all patients treated with autologous serum between July 2014 and December 2019 at a tertiary ophthalmic referral center. The electronic patient record system was searched for all patients with autologous serum eye drop therapy at any time point. These records were subsequently searched for keywords such as infectious keratitis, corneal ulcer, conjunctivitis, or endophthalmitis at any recorded contact. The probability of an association between the therapy with autologous serum eye drops and infectious complications was investigated independently by three corneal specialists and rated as likely, potential, or unlikely. In total, 752 patients were treated with autologous serum eye drops between July 2014 and December 2019. There were 5 384 batches with a total of 107 680 bottles of serum eye drops that had been produced and dispensed for these patients during this period. The records of 291 patient showed a combination of autologous serum therapy and at least one keyword for infectious diseases. In 288 patients, individual case analyses revealed an unlikely association between the therapy and infection, as their infectious episodes occurred either before the start of the therapy, more than 1 month after the therapy ceased, or in the contralateral untreated eye in the case of unilateral therapy. Three cases of infectious keratitis were classified as potentially associated with autologous serum therapy. However, all three patients suffered from chronic anterior eye diseases with a high risk of spontaneous infectious complications independent of therapy with autologous eye drops. None of the infectious events was rated as being likely due to the serum eye drops. Serum eye drops are often used in patients with severe or chronic anterior eye diseases with an intrinsic risk of infectious diseases. Despite these preexisting risk factors, autologous serum eye drops can be considered safe, even in patients with a compromised ocular surface.

The aim of this study is to compare the healing of corneal epithelial defects or ulcers on the corneal graft in comparison with the patient's own cornea after treatment with 100%, undiluted autologous serum eye drops. In a retrospective study over 7 years, we analysed 263 treatments with autologous serum eye drops of persistent corneal epithelial defects (erosions [88%] vs. ulcers [12%]). We compared the epithelial healing tendency of patients with defects on their own cornea (51.9%) vs. patients who had previously undergone penetrating keratoplasty (48.1%). Complete epithelial healing during the 28 days of treatment was considered as therapeutic success. In addition, the recurrence rate of the epithelial defects after finishing the therapy was analysed. 88.2% of the epithelial defects healed during 28 days of therapy. The recurrence rate during follow-up was 5.1%. There was no significant difference with respect to success rate between corneal defects on the patient's own cornea (87.8%) and on the graft (88.6%; p = 0.137). There was a significantly lower success rate for corneal ulcers (74.2%) than for erosions (90.3%; p < 0.001). The recurrence rate of erosions was 4.4%, vs. 4.3% in ulcers during follow-up. The results of our study suggest that autologous serum eye drops are a non-invasive and safe alternative treatment for persistent corneal epithelial defects - with no significant difference in patients with a defect on their own cornea vs. defects on the corneal graft. The success rate, but not the recurrence rate, is significantly worse in ulcers than in erosions.

ObjectivesTo investigate the use of autologous serum (AS) eye drops in patients with ocular surface disorders who were refractory to conventional treatments.MethodsA retrospective cohort study was conducted at a tertiary...

Background and Purpose: Corneal ulcer is one of the most common eye diseases, which can be caused by trauma, chemical agents, and some bacteria, viruses, and chlamydia. Treatment of corneal ulcer has been always a concern in ophthalmology. This concern is due to the major role of cornea in providing and preserving normal vision. Alkali-induced corneal ulcer creates an intense inflammatory reaction to traumatic injuries and this intense inflammation can inhibit the natural epithelial growth and cause fibrosis or scar on cornea.Cornea is an organ in the eye that creates a smooth and clear surface and so, it provides the possibility of light regularly passing through the eye. Any injury of this layer eliminates its transparency and protective capacity. Cornea has few cells and no vessels. Various bacterial, viral, parasitic, and fungal agents can cause severe infections in cornea. After the occurrence of corneal injury, the cells surrounding the injured area including epithelial, stromal, and endothelial cells try to improve the injury by cell division and calling the immune system cells such as neutrophils, macrophages, and monocytes; as a result of this process, the injured area becomes inflamed and edematous. In most cases, due to basic membrane decay and leakage of proteinase, epithelial cells will not be able to provide the connections required for retrieving the layers. So, the distance between epithelial cells increase and the bond between them become weak. As a result of corneal ulcer, increased activity of destructive proteinases and decreased activity of proteases leads to rapid detachment of collagen and other extracellular components of corneal matrix. Significant increase of reactive oxygen species (ROS), increased oxidative condition, and decreased components of antioxidant system occur following corneal injury. In histological studies, various cells of immune system including neutrophils, lymphocytes, monocytes, and macrophages are found in cornea. Increased reactive oxygen species (ROS), increased oxidative stress, and decreased components of antioxidant system are observed in pathologic conditions and in the case of corneal injury. Various studies have reported the role of antioxidants in prevention and treatment of corneal ulcer. The recent studies have indicated that folic acid restores decreased enzymatic and non-enzymatic antioxidants. also, its improving effect is due to inhibition of reactive oxygen species (ROS). Materials and Methods: This study was carried out to investigate the effects of folic acid on corneal burn ulcer healing in 20 adult New Zealand white rabbits in similar weight and age range. The pure folic acid powder needed for this study was purchased from Sigma-USA Co. After general anesthesia, corneal ulcer was induced in the left eye of all rabbits and immediately fluoresce in staining was done to ensure that all of the ulcers were identical in size (6 mm). The rabbits were then divided into four equal groups including three experimental groups and a control group. After the surgery, the experimental groups (first to third groups) were gavaged with 2, 5 and 10 mg/kg body weight folic acid every day for 21 days. Histopathology At the end of the third week, the animals were anesthetized and the eye balls were harvested. After the eyeballs were isolated, the specimens were placed in 10% formalin. After the specimens were fixed in the laboratory, the corneal ulcer was isolated from eyeball. After preparation, the paraffin block sections of 4 microns were prepared and stained using Masson's trichrome staining method. In histopathological grading, the indices affecting wound healing, including angiogenesis, the absence of epithelial layers, corneal edema (stromal edema), irregularities in collagen filaments, and presence or absence of inflammatory cells were investigated. Results and conclusion: The histopathological studies showed that vascularization, inflammation, and corneal matrix edema were significantly reduced, but the epithelium of cornea was increased in folic acid treated rabbits compared to control group (p

This study evaluates the efficacy and safety of autologous serum eye drops (ASEDs) combined with sodium hyaluronate in treating dry eye disease (DED) after phacoemulsification cataract surgery. This retrospective cohort study included patients diagnosed with DED within 1 week to 1 month after cataract surgery at our hospital (August 2022-July 2023). Patients were divided into a combined group (ASEDs + sodium hyaluronate, n = 48) and a monotherapy group (sodium hyaluronate only, n = 63). Propensity score matching was used to balance baseline characteristics, resulting in 48 patients in each group. Both groups were treated for at least 4 weeks. Clinical indicators, including Ocular Surface Disease Index (OSDI), Schirmer I test (SIT), tear breakup time (BUT), fluorescein staining, conjunctival hyperemia, and conjunctival impression cytology, were assessed before and after treatment. After propensity score matching, baseline characteristics were comparable (P > .05). The mean age was 43.83 ± 8.84 years in the combined group and 43.93 ± 8.84 years in the monotherapy group (P = .865), with male proportions of 47.9% and 45.8%, respectively (P = .779). Other variables, including body mass index, disease duration, OSDI, SIT, and BUT, also showed no significant differences. After 4 weeks, the combined group showed significantly greater improvements. OSDI scores decreased to 14.09 ± 4.22 versus 21.50 ± 4.82 (P < .001); SIT increased to 10.23 ± 2.00 mm versus 8.50 ± 1.50 mm (P < .001); BUT extended to 8.18 ± 0.96 seconds versus 6.00 ± 1.00 seconds (P < .001). Fluorescein staining scores reduced to 0.56 ± 0.22 versus 1.86 ± 0.76 (P < .001), with conjunctival hyperemia and conjunctival impression cytology scores also significantly improved in the combined group (P < .001). ASEDs combined with sodium hyaluronate significantly improve both symptoms and ocular surface parameters in post-cataract DED patients, showing superior efficacy over monotherapy and promising clinical value.

Aims/Purpose: To present a case series of patients with persistent epithelial defects (PED) of different etiologies treated with topical insulin after failure of conventional treatments and evaluate its efficacy.Methods: We reviewed the clinical history of 17 patients with PED that were treated with topical insulin since 2020, refractory to conventional treatments.Results: Of the 17 patients with PED that we reviewed, 16 of them achieved reepithelization with topical insulin after failure of conventional treatment. Reepithelization mean time was 29 days (range 6‐60 days). Recurrence of the epithelial defect was observed in 2 patients. None of the patients that achieved epithelization needed extra treatment after topical insulin in order to solve the PED. No adverse effects were reported with the use of topical insuline and it was well tolerated.Conclusions: Topical insulin is a very effective treatment for reepithelization of refractory persistent epithelial defects with good tolerance, no adverse effects, and good availability and cost‐effectiveness in comparison to other treatments.References Aynsley TR. THE USE OF INSULIN IN THE TREATMENT OF CORNEAL ULCERS. Br J Ophthalmol. 1945 Jul;29(7):361‐3. doi: 10.1136/bjo.29.7.361. PMID: 18170130; PMCID: PMC513802. Zagon IS et al. Use of topical insulin to normalize corneal epithelial healing in diabetes mellitus. Arch Ophthalmol. 2007 Aug;125(8):1082‐8. doi: 10.1001/archopht.125.8.1082. PMID: 17698755. Diaz‐Valle D et al. Topical insulin for refractory persistent corneal epithelial defects. Eur J Ophthalmol. 2021 Sep;31(5):2280‐2286. doi: 10.1177/1120672120958307. Epub 2020 Sep 21. PMID: 32951459. Diaz‐Valle Det al. Comparison of the efficacy of topical insulin with autologous serum eye drops in persistent epithelial defects of the cornea. Acta Ophthalmol. 2022 Jun;100(4):e912‐e919. doi: 10.1111/aos.14997. Epub 2021 Aug 18. PMID: 34407296. Wang AL et al. Use of Topical Insulin to Treat Refractory Neurotrophic Corneal Ulcers. Cornea. PMID: 28742619; PMCID: PMC5633504. NaPier E et al. Neurotrophic keratopathy/ current challenges and future prospects. Ann Med.. PMID/ 35243932; PMCID/ PMC8903790.