Serum drops—the last resort for topical treatment after refractive surgery and laser in situ keratomileusis-induced neuropathic epitheliopathy (LINE)

Abstract

Introduction: The idea to apply blood or blood product topical treatment is not new in ophthalmology, but about 40 years ago Ralph was the first to publish this idea. The biochemical properties of serum eye drops are very similar to the water component of the tears. Serum contains several growth factors, including epidermal growth factor, transforming growth factor-β and platelet-derived growth factors, nutrients and proteins, all of which are key components for tissue regeneration. Aim: The aim of this article is to set a prospective study in order to identify and follow patients with laser in situ keratomileusis ( LASIK)-induced neuropathic epitheliopathy (LINE) and analyze the benefits of the application of 20% autologous serum drops. Materials and Methods: A total of 16 subjects (10 females and 6 males) at a mean age of 34 years (19 the youngest and 41 the oldest) were recruited prospectively. All patients were seeking second opinion as they were bothered by discomfort, visual fluctuations, chronic red eye, and pain with different characteristics. Each patient was advised to have a week of wash-out period when only non-preserved artificial tears (Hyabak 0.15%, Thea ®) were applied. Then patients were advised to apply autologous serum drops four times (during the day), and assessment was done on 4th and 8th week. The primary outcome parameters were ocular surface disease index (OSDI), tear break-up time (TBUT) and corneal staining, the secondary included visual acuity and redness. Preparation of the autologous serum drops followed the in-house methodology. Results: The patients were significantly affected by their underdiagnosed condition. Statistical analysis of the outcome parameters demonstrated that only visual acuity did not change significantly. The main outcome parameter OSDI presented highest improvement from 57 ± 12 to 12 ± 6 after 8 weeks of application of 20% autologous serum drops. Corneal staining decreased and TBUT improved in all subjects. Conclusion: Epithelial complications after LASIK are not uncommon and their recognition is the first step to long-term satisfaction of the patients with refractive procedures. After diagnosis of LINE after LASIK, especially with microkeratome, 20% autologous serum drops are an efficient long-term solution. The standard topical treatment usually takes 8 weeks to achieve good results.