The effect of topical autologous serum on graft re-epithelialization after penetrating keratoplasty.
OBJECTIVE
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.


METHODS
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.
Chen
Yan-Ming
YM
Department of Ophthalmology, National Taiwan University Hospital, No. 7 Chung-Shan South Road,Taipei, Taiwan.
Hu
Fung-Rong
FR
Huang
Jehn-Yu
JY
Shen
Elizabeth P
EP
Tsai
Tzu-Yun
TY
Chen
Wei-Li
WL
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000503:physiopathology; D019573:Epithelium, Corneal / Q000502:physiology*; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D009924:Organ Culture Techniques; D011446:Prospective Studies; D012038:Regeneration / Q000502:physiology*; D012307:Risk Factors; D044967:Serum / Q000502:physiology*; D014945:Wound Healing / Q000502:physiology*; D055815:Young Adult