Treatment of Refractory Filamentary Keratitis With Autologous Serum Tears

Purpose: To report a case of filamentary keratitis (FK) successfully treated with autologous serum tears and to review the pathogenesis and management of FK. Methods: Case report including high-resolution anterior segment optical coherence tomography and filament histopathology. Case Report: A 61-year-old Hispanic man presented with pain and photophobia of the right eye. He was found to have a corneal epithelial defect and a small peripheral infiltrate 4 months after Laser Assisted in situ Keratomileusis. After resolution of the epithelial defect, he developed FK. Over a 4-month period, conservative management with aggressive lubrication, lid hygiene, topical corticosteroids, topical cyclosporine, bandage contact lenses, and oral doxycycline failed to resolve the corneal filaments. Notably, treatment with 20% autologous serum tears, four times daily, led to a sustained resolution of the FK within 1 week. Conclusions: This case demonstrates the complexity of FK management and introduces autologous serum tears as a viable management option when conservative approaches to this condition fail.

[1]  A. Celebi,et al.  The efficacy of autologous serum eye drops for severe dry eye syndrome: a randomized double-blind crossover study , 2014, Graefe's Archive for Clinical and Experimental Ophthalmology.

[2]  K. Gumus,et al.  Botulinum toxin injection for the management of refractory filamentary keratitis. , 2012, Archives of ophthalmology.

[3]  Stefano Bonini,et al.  Ocular surface damage by ophthalmic compounds. , 2011, Current opinion in allergy and clinical immunology.

[4]  S. Kinoshita,et al.  Investigation of the corneal filament in filamentary keratitis. , 2009, Investigative ophthalmology & visual science.

[5]  P. Vinciguerra,et al.  Photorefractive keratectomy for primary myopia using NIDEK topography-guided customized aspheric transition zone. , 2009, Journal of refractive surgery.

[6]  A. Behrens,et al.  Autologous serum for ocular surface diseases. , 2008, Arquivos brasileiros de oftalmologia.

[7]  D. Azar,et al.  Preoperative characteristics and a potential mechanism of chronic dry eye after LASIK. , 2008, Investigative ophthalmology & visual science.

[8]  P. Maudgal,et al.  Study of filamentary keratitis by replica technique , 1979, Albrecht von Graefes Archiv für klinische und experimentelle Ophthalmologie.

[9]  M. Zako,et al.  Filamentary keratitis improved by blepharoptosis surgery: two cases. , 2003, Acta ophthalmologica Scandinavica.

[10]  E. Donnenfeld,et al.  Topical cyclosporine A 0.5% as a possible new treatment for superior limbic keratoconjunctivitis. , 2003, Ophthalmology.

[11]  A. Lenton,et al.  Management of Filamentary Keratitis Associated with Aqueous-Deficient Dry Eye , 2003, Optometry and vision science : official publication of the American Academy of Optometry.

[12]  I. Avni,et al.  The beneficial effect of diclofenac sodium in the treatment of filamentary keratitis. , 2001, Archives of ophthalmology.

[13]  A. Bruce,et al.  The conjunctival epithelium in dry eye subtypes: Effect of preserved and non-preserved topical treatments , 2001, Current eye research.

[14]  S. Pflugfelder,et al.  Topical nonpreserved methylprednisolone therapy for keratoconjunctivitis sicca in Sjögren syndrome. , 1999, Ophthalmology.

[15]  R. Beuerman,et al.  A unified theory of the role of the ocular surface in dry eye. , 1998, Advances in experimental medicine and biology.

[16]  B. Kowalik,et al.  Filamentary keratitis--the clinical challenges. , 1991, Journal of the American Optometric Association.

[17]  M. Lemp,et al.  Corneal epithelial cell movement in humans , 1989, Eye.

[18]  J. Whitcher,et al.  Clinical Diagnosis of the Dry Eye , 1987, International ophthalmology clinics.

[19]  G. Zaidman,et al.  The histopathology of filamentary keratitis. , 1985, Archives of ophthalmology.

[20]  W. Rotkis,et al.  Filamentary keratitis following penetrating keratoplasty. , 1982, Ophthalmology.

[21]  F. H. Theodore,et al.  Filamentary keratitis. , 1982, Contact and Intraocular Lens Medical Journal.

[22]  P. Wright,et al.  Corneal mucus plaques. , 1977, American journal of ophthalmology.

[23]  A. Gasset,et al.  Treatment of filamentary keratitis with the soft contact lens. , 1973, American journal of ophthalmology.