Siamak Zarei-Ghanavati M.D., FICO Autologous Serum Tears for the Treatment of Ocular Surface Disease Secondary to Systemic Autoimmune Diseases Tayyeba K. Ali M.D. Allister Gibbons M.D. Siamak Zarei-Ghanavati M.D., FICO Carolina Betancurt O.D. Alma Michelle Mas M.D. Victor L. Perez M.D. The authors have no financial interests to disclose, relevant to the topic of this poster.

Autologous Serum Tears (AST) Effectively treat DES and PED Low frequency of complications (that all cease once discontinued) But, patients with systemic autoimmune disorders have: Circulating immune-complexes Systemic medication These accumulate in the serum and could potentially lead to local side effects. Harloff S, et al. Epitheliotrophic capacity of serum eye drops from healthy donors versus serum from immunosuppressed patients with rheumatoid arthritis. Klin Monbl Augenheilkd. 2008 Mar;225(3):200-6. Poon AC, et al. Autologous serum eyedrops for dry eyes and epithelial defects: clinical and in vitro toxicity studies. Br J Ophthalmol. 2001 Oct;85(10):1188-97.

Purpose To determine the safety and efficacy of autologous serum tears, diluted with normal saline, in patients with systemic autoimmune diseases.

Methods Retrospective non-comparative case series Inclusion criteria Systemic autoimmune disease Serum tear use Exclusion Criteria Serum tear use less than 2 months Incomplete medical records

Methods Definition of Success Duration of the study: Time the patients were using AST We studied the short term effect Longer term effects of AST remain to be seen and are currently being studied. Definition of Success 0 – No improvement 1 – Partial improvement 2 – Complete improvement 3 – Worsening of condition

Results 79 eyes of 40 patients Mean age: 60 ±14 years (28-89 years) Sex: 60 % Female Mean (months) SD +/- Range (months) Follow-up 23 16 2-59 AST use 15 13 2-50

Diagnoses Some patients have more than one diagnosis Sjögren = Sjögren Syndrome; GVHD = Graft Versus host disease; RA = Rheumatoid Arthritis; OCP = Ocular Cicatricial Pemphigoid; SLE = Systemic Lupus Erythematosus

Previous Treatment Medicine % Lubricants 100 Steroids 67 Cyclosporine 0.05% 65 Glaucoma 20 Systemic 66 Systemic medication included: Prednisone, Methotrexate, Tacrolimus & Mycophenolate

Objective Findings Initial BCVA 20/40 (logMAR 0.3±20 letters) *p <0.01 Initial BCVA 20/40 (logMAR 0.3±20 letters) Final BCVA 20/40 *p <0.01 *NSS PEE = persistent epithelial defect FK = filamentary keratitis PED = persistent epithelial defect *Fisher’s exact test

Objective Response to AST 85% 30% 55% 15% 15%

Subjective Response to AST 85% 15% 70% 15% 15%

In Conclusion No complications or adverse events were reported in this series. AST are safe and effective as an adjunct treatment in the stepwise approach to the treatment of ocular surface disease, in the context of autoimmune diseases.