Autologous serum for eye ulcers

Re: Autologous serum for eye ulcers

James Allsop — Mon, 14 Feb 2011 16:48:26 GMT

[quote user="chris jones"]best to draw 10mls ish into serum tubes let it clot then spin it down and draw off the serum. i put the serum into edta tues mix it up then put it into a dropper bottle and used as previously described. its best for deep melting ulcers as an anticollagenase. EDTA helps so thats why i tend to mix it into edta tubes (as serum not whole blood) but I'm not sure if it really is beneficial at that concentration.[/quote]

I remember being told by a local vet opthal a few years ago that putting the serum in EDTA prevented it from working, (something to do with the calcium) so just to use plain serum OR use EDTA solution - sterile water or saline into an EDTA tube upto the marked volume for that tube should be the correct concentration.

Re: Autologous serum for eye ulcers

Vikki Halliday LLB — Mon, 14 Feb 2011 11:54:22 GMT

[quote user="Martin Atkinson"]After recovering from the deafening sound of ophthalmologists', not to mention health and safety officers', jaws collectively hitting the ground when reading the prehistoric idea of using phenol on corneal ulcers[/quote]

It's not that prehistoric! But you do have to be very very careful with it and make sure you have a COSHH assessment and the appropriate amounts of flushing to dilute shoud you get it on your skin, or anywhere else for that matter. (Don't sit down when you apply it.......)

It can work well, but I have to admit I would prefer to grid and use a bandage lens, Eyesoothe or conjunctival graft if it's that bad.

And Barbara's answer about autologous serum above is spot on.

Re: Autologous serum for eye ulcers

Rob Davis — Fri, 11 Feb 2011 18:31:55 GMT

[quote user="Theo Jordaan"]

We do the same for Spitting Cobra ulcerations in South Africa (often the entire cornea of both eyes), Serum + EDTA and add Exocin - also start off with hourly administration for the first 24hrs. Seems to work very well, most recover quickly considering the initial severity.

[/quote]

You're very brave doing hourly eye drops in a Spitting Cobra.....!

Re: Autologous serum for eye ulcers

Theo Jordaan — Thu, 10 Feb 2011 15:24:33 GMT

Re: Autologous serum for eye ulcers

Evelyn Barbour-Hill — Wed, 09 Feb 2011 17:55:48 GMT

Proud to be prehistoric

Re: Autologous serum for eye ulcers

Martin Atkinson — Wed, 09 Feb 2011 17:00:23 GMT

[quote user="Louise Alexander"]

Are bandage lenses a referral thing, or are people using them in general practice?

Louise

[/quote]

After recovering from the deafening sound of ophthalmologists', not to mention health and safety officers', jaws collectively hitting the ground when reading the prehistoric idea of using phenol on corneal ulcers, I have recovered enough to say that I enthusiastically embraced the idea of soft bandage lenses when they first became available 20 years ago and had great initial success after doing a conscious grid keratectomy under topical anaesthesia. However, after many cases losing them frequently and a few where I had to sedate/GA the patient just to get them in I decided I might as well do a grid keratectomy and nictitans flap. I have a few left in the cupboard and might summons the enthusiasm to use them again. I did put one in a cat with keratits sicca and an ulcer the owner of which didn't want a GA and the bandage lens welded to the cornea resulting in loss of the eye - eek! One tip my optician gave me was to use high molecular weight flurescein rather than standard Minims stuff to stop staining the lens when you test to see if the ulcer has healed.

Re: Autologous serum for eye ulcers

Anonymous — Wed, 09 Feb 2011 15:46:02 GMT

we use the protex ones also. correct sizing and placement is essential, especially getting it correctly under the NM. They are widely available although silghtly pricey especially if they end up as a crispy clear bit of plastic on the floor.

You can monitor the cornea closely and the dog can still see unlike a NM flap which will blind the eye (temporarily) and there have been reports of the flap adhering to the denuded stroma although never seen this myself.

Its just physical support to stop the lids rubbing on the healing epithelium of a superficial ulcer and helps to stabilise the tear film to keep the new cells moist so can improve the healing rate ( if they stay there).

We still use phenol here occasionally but I prefer to do grids. depends who you talk to as to whether phenol is a good choice. I find I get better results with grids.

Re: Autologous serum for eye ulcers

bob lehner — Wed, 09 Feb 2011 10:22:57 GMT

[quote user="Barbara Healy"]Louise I've been using Phenol recently on the non-healing superficial Boxer ulcers - delighted with it so far[/quote

Interesting to read that. When I was a young lad phenol was very widely used to cauterise corneal ulcers - probably the standard procedure in fact. Then it seemed to completely fall out of favour. Not sure why - possibly H &S relating to possible spillage/self application or some eminent specialist said it was rubbish ? Haven't seen it used for years - but I guess we must have all thought it worked OK in the past.

Are bandage lenses a referral thing, or are people using them in general practice ? [/quote]

We used Protex Bandage Lenses very regularly in my practice with good results. Can be slightly fiddly to insert and seem to fall out easily in some patients - but if they stay in they can be very useful. Works like a nict flap, but you can see what's going on underneath and apply topical meds easily. I'm surprised they are not more widely used in practice.

Re: Autologous serum for eye ulcers

CatherineThomas — Wed, 09 Feb 2011 07:23:15 GMT

I had a boxer with a superficial ulcer that wouldn't heal despite debriding, 3rd eyelid sutures, autologous serum etc. I ordered a bandage lens from this company: http://www.sjhales.co.uk/prod1.asp?CID=2&PID=144, and it worked really well. I was worried it wouldn't stay in, as it was quite a bouncy boxer, but fortunately the lens stayed in place and when I took it out after 7 days it was much better.

You just need to call them and they'll send you a kind of ruler with cut outs along the edge, then you need to roughly match to the shape/size of the eye. They will send you the lens with the instructions. I found the guy on the phone was very helpful about measuring etc.

Re: Autologous serum for eye ulcers

Louise6732 — Tue, 08 Feb 2011 23:03:59 GMT

[quote user="chris jones"]

superficial ulcers, I like bandage lenses after debriding (if appropriate) although falling out within a couple days is a problem!

[/quote]

Are bandage lenses a referral thing, or are people using them in general practice?

Louise

Re: Autologous serum for eye ulcers

Anonymous — Tue, 08 Feb 2011 22:12:37 GMT

best to draw 10mls ish into serum tubes let it clot then spin it down and draw off the serum. i put the serum into edta tues mix it up then put it into a dropper bottle and used as previously described. its best for deep melting ulcers as an anticollagenase. EDTA helps so thats why i tend to mix it into edta tubes (as serum not whole blood) but I'm not sure if it really is beneficial at that concentration.

I can't remember exactly why but I've always been advised to not put it into edta tubes and allow it to clot in serum tubes. maybe someone will know why

acetylycysteine was very useful (ilube) until it went out of manufacture, good to hear that you can still get it from moorfields. was considering making it up myself from the injectable acetylcysteine but will try moorfields next.

Doxycycline can also be used in melting ulcers, not used it myself as I tend to use bacteriocidal antibiotics as a systemic cover.

superficial ulcers, I like bandage lenses after debriding (if appropriate) although falling out within a couple days is a problem!

Re: Autologous serum for eye ulcers

Stuart Fitzgerald — Tue, 08 Feb 2011 21:39:48 GMT

I normally draw the blood directly into EDTA tubes, spin it down and then separate into more EDTA tubes for storage. Don't know whether I'm doing right or wrong but makes sense to me!

Re: Autologous serum for eye ulcers

Barbara Healy — Tue, 08 Feb 2011 21:07:38 GMT

Louise I've been using Phenol recently on the non-healing superficial Boxer ulcers - delighted with it so far... only done 5-6 so far but so far so good.... I've just debrided under local with a cotton bud then put a tiny bit of Phenol on a cotton bud and just touched it on the ulcer. The cornea should just turn white/grey. Then I just flush the eye well with saline to avoid the phenol burning the conjunctiva etc.

HTH

Re: Autologous serum for eye ulcers

Barbara Healy — Tue, 08 Feb 2011 21:02:07 GMT

Hi,

You can use autologous serum as an anti-collagenase. You take 10mls (if you can get that much - or whatever you can get) in plain tubes, spin it down and pipette off the serum. Put it into a sterile dropper bottle. I assume you're looking for it for melting ulcers? If the ulcer is bad use it hourly for the 1st 24 hrs (yes through the night!) then go to 2 hourly for a further 24 hours then every 4-6 hours depending on how it's looking... I usually use Exocin (Ofloxacin) a human fluroquinolone as my antibiotic on the basis that it's likely Pseudomonas causing the melt. You can keep it in the fridge for 4 days or so. You can also get a product called Euronac (Acetylcysteine) available from Moorfields Eye Hospital in London use it in the same way hourly for 24 hrs etc... You need to register with their pharmacy - It costs about £8.50 (I think) + posting. I've never used EDTA but I know it's possible.

If they're superficial ulcers it's not so effective as the thinking is it's designed to stop a melt... works on the collagenases produced by the bacteria

HTH

Re: Autologous serum for eye ulcers

Louise6732 — Tue, 08 Feb 2011 20:51:41 GMT

I normally use serum if I've done a grid, or in stubborn ulcers. Big dogs like boxers I'll draw 10ml blood and use serum from that, ask owner to keep in fridge and apply a few drops at least QID but every hour if possible! Usually only keeps a few days I think. This is all based on what others do and experience, no hard evidence, but I go by the mantra that serum can do no harm so may as well throw it into the mix? But welcome other's thoughts if they feel mkes things worse?

Also, I've been having very bad luck trying to get ulcers to heal recently, not sure what's going wrong

Louise