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Giuseppe Giannaccare, Piera Versura, Marina Buzzi, Michela Fresina, Claudio Velati, Emilio C Campos; Efficacy of two-month treatment with cord blood serum eye drops in severe dry eye patients: an in vivo confocal microscopy study.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3925.
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© ARVO (1962-2015); The Authors (2016-present)
The efficacy of cord blood serum (CBS) eye drops in the treatment of dry eye (DE) patients has been demonstrated by the decrease of ocular surface staining and the improvement of discomfort symptoms. No data are available about in vivo analysis of corneal cell morphology, and specifically of corneal nerves. The purpose of this study was to investigate for the first time corneal nerve changes by in vivo confocal microscopy (IVCM) after 2-month treatment with CBS eye drops in severe DE patients.
Twenty DE patients (13 females, 7 males; mean age 61.1±12.6 yrs; DEWS severity level 3-4) not responding to conventional therapy were treated in both eyes with CBS eye drops 8 times daily for 2 months, and included in this prospective study. The following parameters were evaluated before (T0 baseline) and after (T1) treatment: subjective symptoms scored by Ocular Surface Disease Index (OSDI) and Visual Analogue Scale (VAS), corneal vital staining graded by Oxford Scale and IVCM performed in the central corneal area for the analysis of giant epithelial cells (GECs), sub-basal nerve density and tortuosity, neuromas, dendritic cell (DC) density. Data were expressed as mean ± standard deviation. Paired Student’s t-test was used to compare values pre- and post-treatment, and correlation among parameters was calculated by Spearman’s rho (significance p<0.05).
OSDI, VAS and Oxford grading values significantly decreased after treatment compared to baseline (respectively, 44.1±18.9 vs 74.2±13.9, 3.7±1.5 vs 8.9±0.9 and 2.4±1.1 vs 3.3±1.3; always p<0.0001). Corneal nerve morphology improved at T1 vs T0 with specific reference to higher nerve density (respectively, 3.38±1.56 vs 2.55±1.62; p<0.001) and lower nerve tortuosity (fig. 1-2) (2.99±0.72 vs 3.47±0.65; p<0.01). GECs and neuromas were reduced at T1 vs T0, respectively from 32% to 20% and from 67.5% to 15% of eyes. No significant variation in the DC density was found at T1 vs T0 (respectively 162.62±162.11 vs 154.76±147.67 cell/mm2; p=0.5). OSDI reduction was correlated with neuromas and DCs at baseline (respectively, rho=0.319 and 0.435; p<0.001).
CBS eye drops significantly improved both corneal nerve morphology and subjective symptoms in severe DE patients. Increasing dendritic cell density and presence of neuromas at baseline were correlated to a greater reduction of symptoms after treatment.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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