BLOG: Here’s blood in your eye
Don’t you love simple solutions to complicated problems?
In our cover story for this issue of Ocular Surgery News, we explore the use of SMILE lenticules for therapeutic keratoplasty procedures — an elegant way to make use of human tissue that would otherwise go to waste. Even more useful might be the use of finger prick whole blood as a treatment for persistent epithelial defects of the cornea, as proposed by a group of investigators at Moorfields Eye Hospital.
The group, which includes Anant Sharma, Rathin Pujari, Rashmi Deshmukh, Chirag Sheth, Madhavan Rajan and Ravi Patel, taught patients how to draw blood from a finger stick and place it in the inferior conjunctival cul-de-sac four times daily for 28 days to treat non-healing corneal ulcers of average duration 259 days caused by diabetes, herpes, post-transplantation, keratoconjunctivitis sicca and post-radiation. Six of the 10 patients healed completely, one healed about 50%, and three had incomplete follow-up data. The treatment has also been explored for advanced dry eye in 16 patients; significant improvements in both signs and symptoms were noted.
Autologous serum has been used for similar applications with good success, but the investigators believe that whole blood has the ability to additionally deliver oxygen as well as other growth factors that are uniquely associated with red blood cells. Autologous serum requires sterile technique for preparation and, at least in the U.S., is usually prepared by a blood bank or compounding pharmacy at a cost of $200 or more per month. Autologous serum is ideally stored refrigerated while whole blood is available anywhere, fresh from the source, coursing through the patient’s veins, at a cost of only a few lancets. And the “bottle” doesn’t expire until the patient does.
How willing are patients to prick their fingers four times a day to obtain whole blood? According to Anant Sharma, patient compliance has not presented an obstacle to the success of this treatment.
Considering its many advantages, autologous blood seems a reasonable approach to non-healing ulcers, especially in the developing world and among patients with limited access to care. It’s still unclear how well our U.S. patients would accept this treatment, but its potential as a DIY, simple, free treatment certainly warrants further exploration.