Posters

Finger-prick autologous blood (FAB) to treat corneal neuropathy secondary to herpes zoster ophthalmicus (HZO)

Poster Details

First Author: S.Balal UK

Co Author(s):    R. Shah   J. Devabattula   A. Sharma              

Abstract Details

Purpose:

The potentially serious nature of herpes zoster (HZ) and the complication post-herpetic neuralgia (PHN) are often underestimated. One in three people will contract HZ in their lifetime. Approximately 30% of Herpes Zoster Ophthalmicus (HZO) patients with ocular involvement experience PHN and it is the most common cause of suicide from chronic pain in individuals over 70. HZ corneal neuropathy is largely neglected but can cause significant keratopathy including neuropathic ulcers. Autologous serum (AS) has been successfully used to treat corneal neuropathy including from HZ. However, it is often difficult to access due to cost, storage and/or contraindications to blood transfusion.

Setting:

Moorefield’s eye clinic, Bedford, United Kingdom

Methods:

A 60yo female presented with left eye (LE) HZO and pseudo-dendrites in December 2016. She was started on oral aciclovir. One week later she had a LE uveitis and was commenced on hourly Maxitrol drops, cyclopentolate and topcal aciclovir.  Two months later the uveitis had resolved but a superior limbic keratitis was noted with dense neuropathy. Patient could not feel cotton wisp or eye drops; right eye had normal sensation. Her only other previous medical history of note was hyperthyroidism in 2003 but no orbital or lid signs presently.

Results:

The patient was instructed on Finger-prick autologous blood (FAB) technique: after washing hands and wiping a fingertip with alcohol street, a lancet is used to draw a drop of blood from the fingertip and applied to inferior fornix. She was instructed to perform 4 times a day but practically could manage 2-3 times per day. Several months later no change in sensation but vision and ocular surface had improved. However, at 5 months post initiation she could feel her cold eye drops and corneal sensation had returned. At latest f/u no corneal stain was noted and sensation continues to improve.

Conclusions:

Corneal nerves participate in the maintenance of ocular surface health and homeostasis. AS has been shown to harbor neurotrophic factors which can restore nerve topography through nerve regeneration over 4-6 months. FAB is a cheaper alternative to serum which is readily accessible and which our group has previously shown is acceptable to patients with severe dry eye, sweating trabeculectomy blebs and persistent epithelial defects without complication. It is currently undergoing a large multi-centre RCT for dry eye. Investigation into its potential to restore corneal nerve topography should be explored further.

Financial Disclosure:

None