Autologous versus allogeneic versus umbilical cord sera for the treatment of severe dry eye disease: a double-blind randomized clinical trial.

PURPOSE: To measure the effects of Autologous serum (AS), Allogeneic Serum (HS) and Umbilical Cord serum (CS) eye drops in severe dry eye disease (DES), as well as to characterize and quantify several molecules in the three sera (albumin, fibronectin; Vitamin A and E; IgG, IgA and IgM; Transforming growth factor ß; Epithelial growth factor). METHODS: Randomized, double-blind, single-centre, three-arm (AS, HS and CS) clinical trial. Sixty-three subjects were included with severe DES, 21 in each arm of the study. Visual acuity, Schirmer test, Breakup time (BUT), lissamine green, fluorescein staining measurements and a questionnaire were performed prior to treatment, and after one-month and three-month follow-up. RESULTS: There was a significant main effect of time on visual acuities, Schirmer and BUT tests and fluorescein and lissamine green staining measurements and questionnaire scores (p = 0.015, p = 0.002, p < 0.001, p < 0.001, p = 0.031 and p < 0.001, respectively), although there was no significant interaction between time and serum type, nor between serum type and the test performed. Regarding the concentration of molecules, in our study AS contained significantly higher concentrations of IgA, IgG and fibronectin whereas HS contained significantly higher concentration of IgM, vitamins A and E, TGF and albumin. Contrary to previous reports, CS did not show higher concentration of any of the molecules analysed. CONCLUSIONS AND RELEVANCE: The three sera were effective in the treatment of severe DES. CS did not contain a higher proportion of molecules compared to AS/HS. More research is needed to assess the effect of AS in patients with DES and autoimmune diseases.

Desprendimiento de retina exudativo como primera manifestación de una preeclampsia grave / Serous retinal detachment as a first sign of severe preeclampsia

El desprendimiento de retina exudativo es una causa poco común de pérdida visual en la preeclampsia. Su patogenia no es del todo conocida, aunque la isquemia coroidea pudiera jugar un papel fundamental. Existen pocos casos reportados en la literatura y la mayoría hace referencia a casos aislados o series cortas de casos. Presentamos el caso de una primigesta de 34 años en el tercer trimestre de embarazo con un desprendimiento de retina exudativo bilateral. La sintomatología visual fue la primera manifestación de una preeclampsia que terminó en cesárea de urgencia. La clínica oftalmológica se resolvió de forma espontánea a las dos semanas de la cesárea(AU)

Exudative retinal detachment is an uncommon cause of loss of visual acuity in preeclampsia. Its pathogenesis is not fully understood, but choroidal ischaemia is known to play a key role. Few cases have been reported, and most of these refer to isolated cases or short series of cases. We describe the case of a primigravida aged 34 years, in the third trimester of pregnancy, with bilateral exudative retinal detachment. The visual symptoms were the first manifestation of preeclampsia, which finally required an emergency caesarean section. The retinal detachment resolved spontaneously within two weeks of the caesarean section(AU)