Evaluation of the therapeutic effect of estrogen replacement therapy combined with autologous serum therapy in controlling severe dry eye disease in perimenopausal women.

To explore the therapeutic effect of estrogen replacement therapy combined with autologous serum therapy in controlling severe dry eye disease in perimenopausal women. A total of 1249 perimenopausal female patients who visited Ziyang Hospital of West China Hospital, Sichuan University from January 2021 to December 2023 were included in this study. After screening, the patients were randomly divided into the normal group, control group, estrogen replacement therapy group (ERT), autologous serum group (AS), and estrogen replacement therapy + autologous serum group (ERT + AS). There were 20 cases in each group, totaling 100 cases. Eye surface data, total luteinizing hormone (LH), estradiol (E2), follicle stimulating hormone (FSH), and endometrial changes were collected before and after treatment in each group. After treatment, the corneal staining area and staining intensity in the ERT + AS group decreased. Compared with the average tear film rupture time of the normal group (15.16 ± 0.73) s, the Control group (5.11 ± 0.45) s decreased to the lowest level while the ERT group (8.27 ± 0.59) s, AS group (8.15 ± 0.72) s, and ERT + AS group (13.37 ± 0.85) s increased, and the ERT + AS group had the most significant increase. Besides, the Schirmer experiment results showed a consistent trend with BUT, with a statistically significant difference (P < 0.05). Meanwhile, our research had shown that after estrogen replacement therapy, FSH and LH in the ERT group and ERT + AS group were significantly reduced, while E2 was significantly increased. There was no statistically significant difference between the two groups (P > 0.05). The Elisa experiment results showed that compared with the normal group, the expression intensity of VEGF, IL-1β, PGE2, and TNF-α inflammatory factors was significantly increased in the control group. After treatment with ERT, AS, and ERT + AS, the expression of thses inflammatory factors gradually decreased, with the ERT + AS group showing the most significant downregulation (P < 0.05). The HE staining results of the endometrium indicated that after intervention measures, the thickness of the endometrium in the ERT group and ERT + AS group significantly increased, the connective tissue arrangement of the endometrium was tight, the structure of the uterine glands was dense, and there was a single layer of columnar epithelium covered with circular uterine glands. The Kupperman score demonstrated that with the prolongation of treatment time, the Kupperman scores of the ERT group and ERT + AS group gradually decreased. After 4 weeks of treatment, both groups had the lowest values, and there was no statistically significant difference between the groups (P > 0.05). Furthermore, the results of the Elisa experiment on endometrial tissue protein fluid showed that compared with the normal group, the expression intensity of IFN-α, IL-12, and TNF-α inflammatory factors was significantly increased in the control group. After treatment with ERT, AS, and ERT + AS, the expression of IFN-α, IL-12, and TNF-α inflammatory factors in the ERT group and ERT + AS group gradually decreased. There was no statistically significant difference between the two groups (P > 0.05). The Elisa experiment results showed that compared with the normal group, the expression intensity of LZM, LF, ALB and sIgA in the control group was significantly decreased, and the difference between the two groups was statistically significant (P < 0.05). After treatment with ERT, AS, and ERT + AS, the expression of inflammatory factors LZM, LF, ALB and sIgA gradually increased, with the ERT + AS group showing the most significant upregulation, and the difference was statistically significant (P < 0.05). The combination of estrogen replacement therapy and autologous serum therapy can effectively ameliorate the symptoms of severe dry eye disease in perimenopausal women and improve their quality of life, which is worthy of further research.