Treatment of dry eye by autologous serum application in Sjögren's syndrome

K Tsubota, E Goto, H Fujita, M Ono, H Inoue, I Saito, S Shimmura, K Tsubota, E Goto, H Fujita, M Ono, H Inoue, I Saito, S Shimmura

Abstract

Aim: To evaluate the efficacy of autologous serum application for the treatment of dry eye in Sjögren's syndrome.

Methods: The stability of essential components (EGF, vitamin A, and TGF-beta) in preserved serum were examined following preservation at 4 degrees C and -20 degrees C. In a primary clinical trial, 12 patients with Sjögren's syndrome were treated with autologous serum (diluted to 20% with sterile saline) for 4 weeks, and vital staining of the ocular surface was compared before and after treatment. The effects of serum on mucin (MUC-1) expression were observed in cultured conjunctival epithelial cells in vitro.

Results: EGF, vitamin A, and TGF-beta were well preserved for up to 1 month in the refrigerator at 4 degrees C and up to 3 months in the freezer at -20 degrees C. Rose bengal and fluorescein scores improved significantly from the initial scores of 5.3 and 5.6 to 1.7 and 2.5 after 4 weeks, respectively. The additive effect of human serum for cultured conjunctival epithelial cells showed significant MUC-1 upregulation on the cell surface.

Conclusion: Autologous serum application is a safe and efficient way to provide essential components to the ocular surface in the treatment of dry eye associated with Sjögren's syndrome.

Figures

Figure 1
Figure 1
Face score, nine different expressions describing the condition of patients' eyes.
Figure 2
Figure 2
Slit lamp photographs stained by rose bengal and fluorescein of the left eye of the patients described (A, B). Note the corneal epithelium was deeply stained by fluorescein. Impression cytology of the bulbar conjunctiva in patients with Sjögren's syndrome (C) stained by PAS staining. There are no goblet cells observed. The epithelial cells are enlarged showing the squamous metaplasia.
Figure 3
Figure 3
Slit lamp photographs stained by rose bengal and fluorescein of the left eye of the patients after the autologous serum treatment for 1 month. (A, B) Note the corneal epithelium dramatically improved. Impression cytology of the bulbar conjunctiva in patients with Sjögren's syndrome also improved (C). Goblet cells are observed with smaller epithelial cells.

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