Autologous Serum Tears for the Treatment of Ocular Surface Disease Secondary to

Systemic Autoimmune DiseasesTayyeba K. Ali M.D.

Allister Gibbons M.D.Siamak Zarei-Ghanavati M.D., FICO

Carolina Betancurt O.D.Alma Michelle Mas M.D.

Victor L. Perez M.D.The authors have no financial interests to disclose, relevant to the topic of this poster.

Autologous Serum Tears (AST)

• Effectively treat DES and PED• Low frequency of complications (that all cease once

discontinued)

But, patients with systemic autoimmune disorders have:• Circulating immune-complexes• Systemic medication• These accumulate in the serum and could potentially

lead to local side effects.Harloff S, et al. Epitheliotrophic capacity of serum eye drops from healthy donors versus serum from immunosuppressed patients with rheumatoid arthritis. Klin Monbl Augenheilkd. 2008 Mar;225(3):200-6. Poon AC, et al. Autologous serum eyedrops for dry eyes and epithelial defects: clinical and in vitro toxicity studies. Br J Ophthalmol. 2001 Oct;85(10):1188-97.

Purpose

• To determine the safety and efficacy of autologous serum tears, diluted with normal saline, in patients with systemic autoimmune diseases.

Methods

• Retrospective non-comparative case series

• Inclusion criteria– Systemic autoimmune disease– Serum tear use

• Exclusion Criteria– Serum tear use less than 2 months– Incomplete medical records

Methods• Duration of the study:– Time the patients were using AST– We studied the short term effect– Longer term effects of AST remain to be seen and are

currently being studied.

0 – No improvement1 – Partial improvement2 – Complete improvement 3 – Worsening of condition

Definition of Success

Results• 79 eyes of 40 patients• Mean age: 60 ±14 years (28-89 years)• Sex: 60 % Female

Mean (months)

SD+/-

Range (months)

Follow-up 23 16 2-59AST use 15 13 2-50

SLE

OCP

RA

GVHD

Sjö-gren

0 5 10 15 20 25

2

3

5

14

23

Diagnoses

• Some patients have more than one diagnosis• Sjögren = Sjögren Syndrome; GVHD = Graft Versus host disease; RA = Rheumatoid Arthritis;

OCP = Ocular Cicatricial Pemphigoid; SLE = Systemic Lupus Erythematosus

Previous Treatment

Medicine %

Lubricants 100Steroids 67

Cyclosporine 0.05% 65

Glaucoma 20Systemic 66

Systemic medication included:Prednisone, Methotrexate, Tacrolimus & Mycophenolate

Objective Findings

• Initial BCVA 20/40 (logMAR 0.3±20 letters)

• Final BCVA 20/40

PEE FK PED0

10

20

30

40

50

60

70

80

90

100

InitialFinal

PEE = persistent epithelial defect FK = filamentary keratitis PED = persistent epithelial defect

*p <0.01

*p <0.01

*NSS

*Fisher’s exact test

Objective Response to AST

Improved No Change Worse0

10

20

30

40

50

60

70

80

90

Complete Partial No Change30% 55% 15%

15%

85%

Subjective Response to AST

Improved No change Worse0

10

20

30

40

50

60

70

80

90Complete Partial No Change

15% 70% 15%

85%

15%

In Conclusion• No complications or adverse events were

reported in this series.

• AST are safe and effective as an adjunct treatment in the stepwise approach to the treatment of ocular surface disease, in the context of autoimmune diseases.