CASE REPORT Management of Bullous Keratopathy-Related Ulcer With Autologous Serum Asimina Mataftsi, M.D., Ph.D., M.R.C.Ophth., Areti Bourtoulamaiou, M.D., Konstantinos Anastasilakis, M.D., Nikolaos G. Ziakas, M.D., Ph.D., and Stavros A. Dimitrakos, M.D., Ph.D. Purpose: The aim of this study was to report the use of autologous serum eyedrops (ASEs) for resolution of a corneal ulcer secondary to bullous keratopathy. Methods: This is a case report. Results: A 66-year-old patient presented with an infected ulcer and hypopyon while using a bandage contact lens for bullous keratopathy. Staphylococcus warneri infection was treated with systemic and topical antibiotics, and ASEs were subsequently administered to enhance reepithe- lialization and to avoid the need for a bandage contact lens. The ASE treatment led to closure of the epithelium layer within 3 weeks, and it was subsequently tapered over the next 3 months. The clinical picture remained stable subjectively and objectively during the 7 months of follow-up. Discussion: To the best of our knowledge, this is the first report of successful use of ASEs in treating and preventing recurrence of ulcers in the context of bullous keratopathy. Key Words: Bullous keratopathy—Autologous serum eyedrops—Contact lens. (Eye & Contact Lens 2013;39: e19–e20) T he management of bullous keratopathy includes several approaches aiming to alleviate symptoms, but it remains a chal- lenge for the clinician. In this case report, autologous serum eye- drops (ASEs) proved to be useful for the resolution and prevention of recurrence of a corneal ulcer secondary to bullous keratopathy. CASE REPORT A 66-year-old woman presented to our tertiary referral center with an infected corneal ulcer and hypopyon in the right eye. She had a history of right chronic iridocyclitis with secondary glaucoma, right trabeculectomy, and pseudophakia. In the recent couple of years, she had developed bullous keratopathy with recurrent epithelial defects, and this was managed with a therapeu- tic contact lens changed on a monthly basis. Visual acuity at initial examination was hand movements in the right eye and 20/25 in the left eye. General health was good, and her medical history only included rheumatoid arthritis without associated keratoconjunctivitis sicca. The patient had been seen by her local ophthalmologist at initiation of symptoms 3 days before and was put on local treatment with tobramycin, ofloxacin, and artificial tears, and systemic diclofenac sodium for pain relief. She presented at the hospital because she had deteriorated. To prevent initiation or progression of endophthalmitis, fre- quency of topical antibiotics was increased to 2 hourly, the anti- inflammatory was stopped, cyclopentolate was added, and intravenous treatment of ciprofloxacin was initiated, while waiting for the results of a corneal scrape culture. This revealed Staphylo- coccus warneri sensitive to oxacillin. The clinical picture had improved with resolution of the hypopyon and reduction of the inflammatory infiltration in the cornea, so the antibiotic regime was not changed. The intraocular pressure remained digitally soft moderate. At 7 days from presentation, the ulcer clinically presented as aseptic without a tendency to diminish in size. An attempt to use a therapeutic contact lens was abandoned 2 days later, as this had no effect on reepithelialization. If anything, it increased the corneal edema and the conjunctival mucous secretions with no pain relief and no reduction of the ulcer size. Autologous serum diluted at 20% 1 was then started 8 times daily, whereas topical antibiotics were tapered. Over the next 3 weeks, the ulcer was reepithelialized, and sodium chloride 5% eyedrops were additionally introduced 4 times daily. The patient’s discomfort was minimized to some epiphora and irritation in the mornings. Neovascularization of the ulcer became evident inferiorly with some intracorneal hemor- rhage (Fig. 1) and applanation tonometry gave a value of approx- imately 10 mm Hg. Autologous serum was tapered as the clinical picture showed stability: reduction by one drop daily every week down to twice daily for a month, once daily for a month, and then stop. There was no recurrence of the ulcer during a follow-up of 7 months after the termination of ASE use, and the visual acuity remained stable. DISCUSSION Autologous serum was first used in the form of eyedrop treatment in 1984 2 in patients with keratoconjunctivitis sicca. Its efficacy and safety has since been shown in several moderate to severe ocular surface disorders: dry eye in the context of Sjogren From the IInd Department of Ophthalmology (A.M., A.B., K.A., S.A.D.), Aristotle University of Thessaloniki, Thessaloniki, Greece; Ist Department of Ophthalmology (N.G.Z.), Aristotle University of Thessaloniki, Thessaloniki, Greece. The author has no funding or conflicts of interest to disclose. Address correspondence and reprint requests to Asimina Mataftsi, M.D., M.R.C.Ophth., IInd Department of Ophthalmology, Aristotle University of Thessaloniki, General Hospital of “Papageorgiou,” Periferiaki Odos Thessalonikis, N. Efkarpia 56403, Thessaloniki, Greece; e-mail: mataftsi@ doctors.org.uk Accepted May 14, 2012. DOI: 10.1097/ICL.0b013e31825f6386 Eye & Contact Lens  Volume 39, Number 4, July 2013 e19 Copyright @ Contact Lens Association of Opthalmologists, Inc. Unauthorized reproduction of this article is prohibited.