Autologous Serum-Based Eye Drops for Treatment of Ocular Surface Disease: A Report by the American Academy of Ophthalmology.

PURPOSE: To describe the safety and effectiveness of using autologous serum-based eye drops for the treatment of severe dry eye and persistent corneal epithelial defect. METHODS: Literature searches of the PubMed and Cochrane Library databases were conducted most recently in March 2019. The searches identified 281 citations, which were reviewed in abstract form. Of these, 48 were selected for a full-text review, and 13 met the inclusion criteria and were assigned a quality-of-evidence rating by the panel methodologist. Eight of these studies were rated level II and 5 were rated level III; there were no level I studies. RESULTS: This analysis included 10 studies of the use of autologous serum-based eye drops for severe dry eye disease and 4 studies of persistent epithelial defect. Several studies showed good effectiveness, with some improvement in symptoms, signs, or both. Eight of the studies reported improved symptoms for severe dry eye disease, and all noted improvement in at least 1 clinical sign. For persistent epithelial defects, all of the studies showed improvement, with 3 of the 4 demonstrating an improvement rate of more than 90%. Adverse events were rare. CONCLUSIONS: Although autologous serum-based tears may be effective in the treatment of severe dry eye and persistent epithelial defect, conclusions are limited owing to the absence of controlled trials.

Herpes zoster ophthalmicus: acute keratitis.

PURPOSE OF REVIEW: Herpes zoster is a common condition, and involvement of the trigeminal nerve results in herpes zoster ophthalmicus (HZO). Acute keratitis is one of the most common of these ocular complications associated with HZO. The findings associated with and the management of acute zoster keratitis will be reviewed. RECENT FINDINGS: The incidence rate of herpes zoster has been on the rise over the past several decades. At the same time, the average patient age at presentation is declining with similar trends also seen in HZO. The cause of these changes has yet to be determined. Our understanding of corneal involvement in HZO continues to evolve with new imaging demonstrating viral particles within keratocytes in a case of zoster stromal keratitis. New medications such as topical ganciclovir are also helping to better manage acute zoster keratitis that is unresponsive to oral antiviral therapy. SUMMARY: Acute zoster keratitis can lead to permanent vision loss. Early diagnosis and management may help reduce these potentially devastating complications. Oral and topical antiviral medications can play a role in managing the acute disease, and herpes zoster vaccinations are important for prevention of disease. Further research must be done to establish standards for treatment of anterior segment complications from herpes zoster.