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Hwang and Cho: The Effect of 5% Serum Albumin on Intractable Corneal Epithelial Keratitis: a Case Series and Literature Review
Original Article

J Korean Ophthalmol Soc 2018;59(5):403-409.

Published online: 25 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.5.403

The Effect of 5% Serum Albumin on Intractable Corneal Epithelial Keratitis: a Case Series and Literature Review

Yousook Hwang, MD, Yang Kyung Cho, MD, PhD

Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Yang Kyung Cho, MD, PhD Department of Ophthalmology, The Catholic University of Korea St. Vincent's Hospital, #93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea Tel: 82-31-240-7340, Fax: 82-31-251-6225 E-mail: yangkyeung@hanmail.net

Received 11 January 2018       Revised 22 February 2018       Accepted 20 April 2018

Copyright © 2018 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We report five cases of intractable epithelial keratitis in which 5% serum albumin showed significant effects as a topical treatment when compared with other previous conservative treatments based on a literature review.

Methods

This was a retrospective observational case series of five patients with intractable corneal epithelial keratitis who used serum albumin as a topical treatment. All patients had already been using other conservative treatments such as nonpreserved artificial tears and autologous serum eye drops. The size of the epithelial defect and the time taken for closure of the epithelial defect were observed.

Results

The study involved five patients with intractable corneal epithelial disease with a mean follow-up time of 6 months. The epithelial lesions improved with the use of 5% serum albumin from the beginning of treatment and lasted throughout the fol-low-up period. The mean time to complete epithelial closure using 5% serum albumin eye drops was 21 days.

Conclusions

Treatment with 5% serum albumin eye drops may have a significant and stable effect in the treatment of intractable corneal epithelial disease.

Keywords: Intractable corneal epithelial keratitis, Serum albumin eye drop

References

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Figure 1.
Persisted corneal epithelial defects after alkaline chemical burn. (A) Immediately after chemical burn. (B) Immediately before using 5% serum albumin. (C) 3 weeks after using 5% serum albumin. (D) 6 weeks after using 5% serum albumin.
jkos-59-403f1.tif
Figure 2.
Corneal epithelial defect due to Graft-versus-host reaction after allograft rejection. (A) Continous corneal epithelial defect. (B) Immediately before using 5% serum albumin. (C) 2 weeks after using 5% serum albumin.
jkos-59-403f2.tif
Figure 3.
Epithelial defect due to exposure keratopathy after blepharoplasty. (A) Epithelial defect due to persistent corneal exposure. (B) Immediately before using 5% serum albumin. (C) 4 weeks after using 5% serum albumin.
jkos-59-403f3.tif
Figure 4.
Epithelial defect in patients with postherpeticneurotrophic keratitis. (A) Repeated corneal epithelial defect. (B) Immediately after amniotic transplantation. (C) Corneal epithelium deteriorating again after amniotic transplantation. (D) 1 weeks after using 5% serum albumin. (E) 4 weeks after using 5% serum albumin.
jkos-59-403f4.tif
Figure 5.
Epithelial defect persisted after penetrating keratoplasty. (A) Before using 5% serum albumin, 3 weeks after penetrating keratoplasty (punctal plug, autologous serum eye drops, preservativefree artificial tears are already in use). (B) 1 weeks after using 5% serum albumin. (C) 3 weeks after using 5% serum albumin.
jkos-59-403f5.tif
Figure 6.
The Cohn process, developed by Edwin J. Cohn, is a series of purification steps with the purpose of extracting albumin from blood plasma. The process is based on the differential solubility of albumin and other plasma proteins based on pH, ethanol concentration, temperature, ionic strength, and protein concentration. Albumin has the highest solubility and lowest isoelectric point of all the major plasma proteins. This makes it the final product to be precipitated, or separated from its solution in a solid form. vWF = von willebrand factor.
jkos-59-403f6.tif
Table 1.
Summary of patients who used 5% serum albumin
Patient No. Clinicaldiagnosis Age (years) Sex p Follow-up eriod (month) Affected eye Size of epithelial defect before 5% albumin use (width × height, mm2) Time until epithelialdefect closure (days)
1 Alkali burn 49 M 4 Left 8.0 × 8.0 30
2 GVHD 62 M 2 Left 1.0 × 1.0 15
3 Exposure keratopathy 80 F 8 Right 5.0 × 2.0 30
4 Herpes zoster 58 F 9 Left 2.5 × 2.5 10
  Neurotrophic ulcer            
5 Epithelial defect after PKP 67 M 7 Left 1.5 × 1.5 20

GVHD = graft-versus-host disease; M = male; F = female; PKP = penetrating keratoplasty.

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