Ocular Surface Disease
Royal College of Ophthalmologists
Serum eye drops (SED) are recommended for the following patients:
Patients who have refractory or partially responsive acute or chronic severe ocular surface disease (OSD) where licensed interventions have been considered.
Patients with other ocular surface conditions such as recurrent corneal erosions, persistent epithelial defects, and limbal epithelial stem cell failure if licensed interventions have been unsuccessful.
Patients who require supportive therapy, such as patients undergoing ocular surface reconstruction.
Allo-SED should be considered as an option in patients with uncontrolled diabetes, with refractory immune-mediated diseases, on cytotoxic agents (or where their by-products are known to damage proliferating cells, such as cyclophosphamide), or with sepsis.
Detailed serum constituent analyses of sequential donations from patient and healthy donors is required to interrogate biovariability of each donation and the impact this could have on ocular surface health.
Further work on the development of protocols that reduce variability of biological constituents is required (eg, pooling of serum samples from multiple donors with measured ranges of main constituents).
Treatment for patients with OSD should begin by implementing conservative self-help options and supplementary tears with nonpreserved artificial substitutes; tear modification with acetylcysteine; where possible, tear stimulation with pilocarpine; disease modification with anti-inflammatories; and surface modification strategies. If there is absence of significant relief for the patient as measured by clinical and patient-reported outcomes, SED may be considered as a therapeutic option.
Reference
Rauz S, Koay SY, Foot B, et al. The Royal College of Ophthalmologists Guidelines on Serum Eye Drops for the Treatment of Severe Ocular Surface Disease: Full Report. Eye (Lond). 2017 Nov 17. https://www.nature.com/articles/eye2017209.pdf
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Cite this: John Anello, Brian Feinberg, John Heinegg, et. al. New Clinical Practice Guidelines, December 2017 - Medscape - Dec 06, 2017.
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