Received: 17 February 2020; Published on-line: 27 October 2020

Efficacy of adjunctive autologous serum in the comprehensive treatment of bacterial corneal ulcers in patients with diabetic mellitus 

O. V. Zavoloka, P. A. Bezditko

Kharkiv National Medical University, Department of Ophthalmology; Kharkiv (Ukraine)

E-mail: оlesya_zavoloka@yahoo.com

TO CITE THIS ARTICLE: Zavoloka OV, Bezditko PA. Efficacy of adjunctive autologous serum in the comprehensive treatment of bacterial corneal ulcers in patients with diabetic mellitus. J.ophthalmol.(Ukraine).2020;5:29-35. http://doi.org/10.31288/oftalmolzh202052935    

Background: The presence of diabetic keratopathy associated with diabetic corneal neuropathy should be taken into account in the management of corneal inflammation in patients with diabetes mellitus.

Purpose: To determine the impact of adjunctive topical autologous serum eye drops on delayed healing of bacterial corneal ulcers in patients with type 1 diabetes mellitus (DM1).

Material and Methods: We retrospectively reviewed the results of observing 19 DM1 patients (19 eyes) with bacterial corneal ulcers who exhibited delayed healing of corneal ulceration and whose corneal smears and scrapings taken one week after initiation of treatment were bacteriologically negative. Patients had a routine eye examination (visual acuity, tonometry, and slit-lamp biomicroscopy of anterior and posterior eye segments), bacteriological studies, fluorescein dye test, anterior eye OCT and non-contact corneal esthesiometry. Patients of the control group (9 individuals) continued receiving only background therapy (topical antiseptics, antioxidants, repairing agents, artificial tears, and mydriatics and systemic anti-inflammatory agents), whereas patients of the main group began receiving autologous serum eye drops in addition to background therapy of topical antiseptics, mydriatics and systemic anti-inflammatory agents. Clinical picture data for day 1 (visit 1, before administering the treatment) and days 7 (when corneal samples and scrapings were re-taken), 14 (when bacteriology results became available and main group patients were additionally administered autologous serum), 17, 21 and 24 were analyzed.

Results: In DM1 patients with delayed healing of bacterial corneal ulcers, the use of adjunctive autologous serum eye drops after eradication of the offending microorganisms resulted in reductions in precorneal injection and size and depth of the ulcer defect and complete resolution of corneal infiltration and edema of the corneal tissue surrounding the ulcer as early as day 3, and recovery of all patients and a 32.6% improvement in corneal sensitivity on day 10.

Conclusion: Using adjunctive topical autologous serum eye drops after eradication of the offending microorganisms was found to be efficacious in the comprehensive treatment of delayed healing of bacterial corneal ulcers in patients with DM1.

Keywords: diabetes mellitus, bacterial corneal ulcer, autologous serum, corneal sensitivity



1.Vieira-Potter VJ, Karamichos D, Lee DJ. Ocular complications of diabetes and therapeutic approaches. Biomed Res Int. 2016; 2016:3801570. 

Crossref   PubMed 

2.Kaji Y. Prevention of diabetic keratopathy. Br J Ophthalmol.  2005; 89:254–5. 

Crossref    PubMed

3.Austin A, Lietman Т, Rose-Nussbaumer J. Update on the Management of Infectious Keratitis. Ophthalmology. 2017:124(11):1678-89.  

Crossref    PubMed

4.Schulze SD, Sekundo W, Kroll P. Autologous serum for the treatment of corneal epithelial abrasions in diabetic patients undergoing vitrectomy. Am J Ophthalmol. 2006;142(2):207–11. 

Crossref    PubMed

5.Troichenko LF. [Efficacy of the improved method for treating persistent epithelial defects and torpid ulcers of the cornea]. Cand Sc (Med) Thesis. Odesa: Filatov Institute of Eye Disease and Tissue Therapy. 2013. Ukrainian. 

6.Geerling G, MacLennan S, Hartwig D. Autologous serum eye drops for ocular surface disorders. Br J Ophthalmol. 2004 Nov;88(11):1467-74.  

Crossref    PubMed

7.Lekhanont K, Jongkhajornpong P, Choubtum L, Chuckpaiwong V.  Topical 100% serum eye drops for treating corneal epithelial defect after ocular surgery. Biomed Res Int. 2013;2013:521315. 

Crossref    PubMed

8.Zavoloka OV, Besditko PA, Lukhanin OO. Efficacy of a novel non-contact corneal esthesiometer in assessing the neurotrophic status of the cornea in type I diabetic patients with bacterial keratitis. J Ophthalmol (Ukraine). 2019;6:29-33.


9.Wang B, Yang S, Zhai H, Zhang Y, Cui C, Wang J, Xie L. A comparative study of risk factors for corneal infection in diabetic and non-diabetic patients. Int J Ophthalmol. 2018;11(1):43–7. 


10.Grzybowski A,  Kanclerz P, Huerva V, Ascaso F, Tuuminen R.  Diabetes and Phacoemulsification Cataract Surgery: Difficulties, Risks and Potential Complications. J Clin Med. 2019;8(5):716. 

Crossref    PubMed

11.Pflugfelder SC. Is autologous serum a tonic for the ailing corneal epithelium? Am J Ophthalmol. 2006 Aug;142(2):316-7. 

Crossref    PubMed 


The authors certify that they have no conflicts of interest in the subject matter or materials discussed in this manuscript.