The Effect of Topical Autologous Serum on Graft Re-epithelialization After Penetrating Keratoplasty

Chen, Yan-Ming; Hu, Fung-Rong; Huang, Jehn-Yu; Shen, Elizabeth P.; Tsai, Tzu-Yun; Chen, Wei-Li

doi:10.1016/j.ajo.2010.03.024

« Previous Next »American Journal of Ophthalmology
Volume 150, Issue 3 , Pages 352-359.e2, September 2010

The Effect of Topical Autologous Serum on Graft Re-epithelialization After Penetrating Keratoplasty

Yan-Ming Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Ophthalmology, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan
Fung-Rong Hu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Center of Corneal Tissue Engineering and Stem Cell Biology, National Taiwan University Hospital, Taipei, Taiwan
Jehn-Yu Huang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
Elizabeth P. Shen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan
Tzu-Yun Tsai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University College of Medicine, Taipei, Taiwan
Wei-Li Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Center of Corneal Tissue Engineering and Stem Cell Biology, National Taiwan University Hospital, Taipei, Taiwan
- Inquiries to Wei-Li Chen, Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan

Accepted 24 March 2010. published online 24 June 2010.

Purpose

To analyze factors influencing corneal graft re-epithelialization after penetrating keratoplasty (PK) and evaluate the effect of topical autologous serum in promoting graft re-epithelialization.

Design

Prospective interventional study.

Methods

We analyzed 165 eyes of 165 patients who underwent PK between January 1, 2005 and December 31, 2007. Patients were divided into 2 groups according to routine use or non-use of postoperative 20% topical autologous serum. Postoperative slit-lamp examination after fluorescein staining was performed, and graft re-epithelialization time was recorded. Recipient/donor characteristics, surgical variables, and topical use of autologous serum were analyzed for their effects on post-PK graft re-epithelialization. Statistical analysis was performed by univariate and multivariate regression analysis using the ordinal logistic fit model to assess the potential risk factors influencing graft re-epithelialization after PK.

Results

In univariate analysis, diabetes mellitus (DM), longer death-to-storage time and death-to-surgery time of the donor, and larger recipient size significantly delayed graft re-epithelialization (P < .05). Use of autologous serum significantly expedited graft re-epithelialization (P = .004). In multiple regression analysis, only DM in the recipient (odds ratio [OR] = 5.10, P < .001), postoperative use of autologous serum (OR = 0.54, P = .046), and larger graft size (OR = 4.44, P < .001) influenced graft re-epithelialization. The beneficial and healing effect of autologous serum is particularly significant in diabetic recipients and larger grafts.

Conclusions

Several factors may influence graft re-epithelialization after PK. Graft re-epithelialization time was longer in diabetic recipients and larger grafts. Use of autologous serum may be a beneficial strategy in these patients with potentially delayed epithelial healing.