Eyeworld

EW CORNEA 98 September 2017 by Vanessa Caceres EyeWorld Contributing Writer Dr. Akpek and fellow authors judged the evidence from this trial as low certainty. In the two other trials, there was no difference in symptom scores, fluorescein staining scores, tear film breakup times, or Schirmer's scores after 2 to 4 weeks of follow-up. However, one of the studies found low certainty evidence for some improvement in rose bengal staining scores. Only one of the three trials reported adverse events, which were signs of conjunctivitis with negative culture in two of 12 participants. The problem resolved in both patients. "There might be some benefit in symptoms with autologous serum compared with artificial tears in the short term, but we found no evidence of an effect after 2 weeks of treatment," the authors concluded. Corneal specialists react Corneal specialists who use autol- ogous serum for dry eye and other ocular surface conditions had mixed reactions to the results. "I was surprised that there was very little evidence for autologous serum tears. We use them a fair amount with reasonable success," said Christopher Rapuano, MD, director of the cornea service, Wills Eye Hospital, Philadelphia. "Clinically we have the impres- sion that these agents work, but there have been few randomized controlled trials to truly test this," said Anat Galor, MD, associate professor of clinical ophthalmology, Bascom Palmer Eye Institute, Uni- versity of Miami. On the other hand, "The results are not surprising to me as I know from my practice that serum does not work for everyone," said Bennie Jeng, MD, professor and chair, titative data for most outcomes and unclear or high risk of bias. There were two other trials that did not report data in a way that it could be used to compare outcomes between treatment groups appropriately. Ultimately, the authors were able to focus on three trials that had a cumulatively small number of patients. In one trial with 20 participants, there was some evidence of improve- ments in symptoms with the use of autologous serum compared with ar- tificial tears after 2 weeks of use. The same trial had mixed results when comparing fluorescein staining and rose bengal staining scores, and there was no clinically meaningful difference in Schirmer's test scores. perience is that they do work," said coauthor Esen Akpek, MD, Ben- dann Family Professor of Ophthal- mology and Rheumatology, director, Ocular Surface Disease and Dry Eye Clinic, and associate director, Johns Hopkins Jerome L. Greene Sjögren's Syndrome Center, Wilmer Eye Insti- tute at Johns Hopkins, Baltimore. The authors searched through a variety of databases for randomized controlled trials that compared au- tologous serum tears versus artificial tears through July 2016. One challenge they identified right away is that there are not stan- dardized studies to easily compare against one another in the area of autologous serum. Certain trials were eliminated due to lack of quan- Cochrane review finds inconclusive evidence for their benefit I f you're looking for concrete proof that autologous serum tears can help patients with dry eye, the research isn't there yet. An analysis published earlier this year in Cochrane Database of Systematic Reviews did not find across-the-board evidence that autol- ogous serum eye drops are effica- cious compared with artificial tears alone, saline, placebo, or no treat- ment at all in adults with dry eye. 1 "What we found is that there is no evidence that autologous serum tears work, although my clinical ex- Closer look at autologous serum tears for dry eye Severe corneal punctate epithelial erosions in a patient with confirmed Sjögren's disease Source: Inna Ozerov, MD Research highlight continued on page 100

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