Autologous serum promotes post-PK graft healing, especially in patients with diabetes or larger grafts

The authors conducted this prospective study to analyze factors influencing corneal graft re-epithelialization after penetrating keratoplasty (PK) and to evaluate the possible beneficial effects of topical autologous serum.

They analyzed the effects of recipient and donor characteristics, surgical variables and topical use of autologous serum on re-epithelialization in 165 patients (165 eyes) who underwent PK during a three-year period. The 83 patients treated during the first half of the study were assigned to postoperative use of nonautologous serum. The remaining patients were prescribed 20% autologous serum eye drops for use bi-hourly during waking hours in the affected eye. Corneal epithelial healing was recorded daily by slit-lamp examination with fluorescein staining.

Univariate analysis revealed that diabetes mellitus in the recipient, larger trephination size and longer death-to-storage time and death-to-surgery time of the donor corneal buttons significantly delayed graft re-epithelialization (P < 0.05). Postoperative use of 20% topical autologous serum significantly expedited graft re-epithelialization (P = 0.004). Multiple regression analysis showed that diabetes in the recipient (P < 0.001), postoperative use of autologous serum (P = 0.046) and larger graft size (P < 0.001) influenced graft re-epithelialization. The beneficial and healing effect of autologous serum was particularly significant among recipients with diabetics or larger grafts.

The authors conclude that the use of autologous serum was found to be both efficient and safe for promoting post-PK graft re-epithelialization, especially in recipients with diabetes or larger grafts. These findings confirm the value of topical autologous serum in patients with potential epithelial healing problems.