title: Autologous Serum Tears for Treatment of Photoallodynia in Patients with Corneal Neuropathy: Efficacy and Evaluation with In Vivo Confocal Microscopy.
abstract: OBJECTIVE
  Patients suffering from corneal neuropathy may present with photoallodynia; i.e., increased light sensitivity, frequently with a normal slit-lamp examination. This study aimed to evaluate the efficacy of autologous serum tears (AST) for treatment of severe photoallodynia in corneal neuropathy and to correlate clinical findings with corneal subbasal nerve alterations by in vivo confocal microscopy (IVCM).
  
  
  METHODS
  Retrospective case control study with 16 patients with neuropathy-induced severe photoallodynia compared to 16 normal controls. Symptom severity, clinical examination and bilateral corneal IVCM scans were recorded.
  
  
  RESULTS
  All patients suffered from extreme photoallodynia (8.8±1.1) with no concurrent ocular surface disease. Subbasal nerves were significantly decreased at baseline in patients compared to controls; total nerve length (9208±1264 vs 24714±1056 μm/mm(2); P<.0001) and total nerve number (9.6±1.4 vs 28.6±2.0; P<.0001), respectively. Morphologically, significantly increased reflectivity (2.9±0.2 vs 1.8±0.1; P<.0001), beading (in 93.7%), and neuromas (in 62.5%) were seen. AST (3.6±2.1 months) resulted in significantly decreased symptom severity (1.6±1.7; P=.02). IVCM demonstrated significantly improved nerve parameters (P<.005), total nerve length (15451±1595 μm/mm(2)), number (13.9±2.1), and reflectivity (1.9±0.1). Beading and neuromas were seen in only 56.2% and 7.6% of patients.
  
  
  CONCLUSIONS
  Patients with corneal neuropathy-induced photoallodynia show profound alterations in corneal nerves. AST restores nerve topography through nerve regeneration, and this correlated with improvement in patient-reported photoallodynia. The data support the notion that corneal nerve damage results in alterations in afferent trigeminal pathways to produce photoallodynia.
authors.affiliation: Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
authors.forename: Shruti
authors.initials: S
authors.lastname: Aggarwal
authors.affiliation: Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Kheirkhah
authors.affiliation: Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
authors.forename: Bernardo M
authors.initials: BM
authors.lastname: Cavalcanti
authors.affiliation: Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cruzat
authors.affiliation: Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
authors.forename: Clara
authors.initials: C
authors.lastname: Colon
authors.affiliation: Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
authors.forename: Emma
authors.initials: E
authors.lastname: Brown
authors.affiliation: Pain/Analgesia Imaging Neuroscience (P.A.I.N.) Group, Department of Anesthesia, Boston Children's Hospital, Center for Pain and the Brain, Harvard Medical School, Waltham, MA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Borsook
authors.affiliation: Department of Neurology, Charité University Medicine Berlin, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Prüss
authors.affiliation: Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA. Electronic address: pedram_hamrah@meei.harvard.edu.
authors.forename: Pedram
authors.initials: P
authors.lastname: Hamrah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003315:Cornea / Q000294:innervation* / Q000503:physiopathology; D003316:Corneal Diseases / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008027:Light / Q000009:adverse effects*; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D012189:Retrospective Studies; D012677:Sensation / Q000502:physiology; D013666:Tears
keywords: autologous serum tears; corneal neuropathy; laser in vivo confocal microscopy; light sensitivity; nerve growth factor; photoallodynia; regeneration