AUTOLOGOUS SERUM Questions and Answers
AUTOLOGOUS (means it comes from the patient) SERUM (the liquid or clear part of a patient's blood that is separated from the red blood cells or cellular part) has been used for years to treat a wide variety of eye surface disorders, such as severe dry eye corneal infections and ulcers, and other ocular surface disorders, such as Sjögren's syndrome (SS), superior limbic keratoconjunctivitis, graft-versus-host disease, Stevens-Johnson syndrome, ocular cicatricial pemphigoid, recurrent corneal erosions, neurotrophic keratopathy, Mooren's ulcer, aniridic keratopathy, and postkeratorefractive surgery.
I have prescribed AS for almost 18 years to help a patient's eye heal faster from inflammation, infection, autoimmune diseases, or other disorders.
AS has been proven to maintain the shape and function of the corneal cells much better
than pharmaceutical tear substitutes, since its biological properties are similar
to natural tears. AS contains a complex composition of water, salts, proteins,
vitamins, lipids, immunoglobulines and growth factors which are similar or even better in some cases than the biological nutrients that are found in a "good" or normal tears [1, 4–6]. Serum and tears show similar constituent concentrations, with the exception of greater amounts of vitamin A, lysozyme, transforming growth factor-β (TGF-β), and fibronectin and reduced amounts of immunoglobulin A (IgA), epithelial growth factor (EGF), and vitamin C in serum when compared with tears [1, 2, 4].
AS eye drops are prepared as non-preserved diluted blood solutions [1, 7–9] for most of these treatments. Sometimes 100% serum is used.
Even though many doctors and scientists worldwide have conducted studies that
show the benefits of using autologous serum drops, the US does not currently
have a Food and Drug Administration (FDA)-approved protocol or guidance for
this process since it is a patient's own blood and not a drug.
To make your eyedrops we will need to collect some of your blood in several
tubes and it will need to be allowed to clot for one to two hours. Then it will
be placed into a machine that spins the blood at a very high speed, causing
the red cells to separate from the serum. The serum will be taken and mixed
with non-preserved artificial tears or balanced saline solution at a specific concentration.
The bottles need to be kept in your freezer at home and you can remove one bottle at the time, leaving it to thaw in the refrigerator. This refrigerated bottle usually lasts 7-10days and is then thrown out.
Remember, after thawing, the bottle should be kept in the refrigerator at all times. Bottles cannot be left on the counter as bacteria can grow and lead to an infection (which Dr. Cremers has never seen but has been reported).
Most patients start out using AS 4x per day. Some patients feel relief with just 2x per day; some patients need to use them every hour.
AS eye drops improve the quality of life of severe dry eye patients, although reports of the correlation between this improvement and clinical measurements are scarce in the literature. There is no standard dilution of serum for use in anterior segment applications as each patient may respond differently to different dilutions. We usually start at 20% dilution, unless I feel a stronger % is needed or a bad corneal infectin is present. The more diluted the AS, the longer it will last. Some patients need 50% dilution. Some need 100% to feel relief. Time will tell what is the most diluted % of AS the patient can use and still feel relief.
Rarely, AS provides no relief. It used to be I could count on 1 hand the number of patients who did not improve on AS. Now with more patients using AS, there is about a 4-5% chance it will not help. If AS does not help, we recommend using Platelet Rich Plasma. I only have 4 patients to date out of hundreds who did not feel improvement with PRP drops.
References:
1. Pan Q., Angelina A., Zambrano A., et al. Autologous serum eye drops for dry eye. The Cochrane Database of Systematic Reviews. 2013;8CD009327 [PMC free article] [PubMed]
2. Dogru M., Tsubota K. Pharmacotherapy of dry eye. Expert Opinion on Pharmacotherapy. 2011;12(3):325–334. doi: 10.1517/14656566.2010.518612. [PubMed] [Cross Ref]
3. Quinto G. G., Campos M., Behrens A. Autologous serum for ocular surface diseases. Arquivos Brasileiros de Oftalmologia. 2009;71(6):47–54. [PubMed]
4. Tsubota K., Goto E., Shimmura S., Shimazaki J. Treatment of persistent corneal epithelial defect by autologous serum application. Ophthalmology. 1999;106(10):1984–1989. doi: 10.1016/S0161-6420(99)90412-8. [PubMed] [Cross Ref]
5. Noble B. A., Loh R. S. K., MacLennan S., et al. Comparison of autologous serum eye drops with conventional therapy in a randomised controlled crossover trial for ocular surface disease. British Journal of Ophthalmology. 2004;88(5):647–652. doi: 10.1136/bjo.2003.026211. [PMC free article] [PubMed][Cross Ref]
6. Geerling G., MacLennan S., Hartwig D. Autologous serum eye drops for ocular surface disorders. British Journal of Ophthalmology. 2004;88(11):1467–1474. doi: 10.1136/bjo.2004.044347.[PMC free article] [PubMed] [Cross Ref]
7. Matsumoto Y., Dogru M., Goto E., et al. Autologous serum application in the treatment of neurotrophic keratopathy. Ophthalmology. 2004;111(6):1115–1120. doi: 10.1016/j.ophtha.2003.10.019. [PubMed][Cross Ref]
8. Tsubota K., Goto E., Fujita H., et al. Treatment of dry eye by autologous serum application in Sjogren's syndrome. British Journal of Ophthalmology. 1999;83(4):390–395. doi: 10.1136/bjo.83.4.390.[PMC free article] [PubMed] [Cross Ref]
9. Tananuvat N., Daniell M., Sullivan L. J., et al. Controlled study of the use of autologous serum in dry eye patients. Cornea. 2001;20(8):802–806. doi: 10.1097/00003226-200111000-00005. [PubMed][Cross Ref]
A Case-Control Study on the Oxidative Balance of 50% Autologous Serum Eye Drops.
Gus PI1, Marinho D2, Zelanis S2, Belló-Klein A2, Locatelli C3, Nicola F2, Kunzler AL2, Fernandes TR4, Carraro CC2, Barbosa L5.
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