Active Pedicle Epithelial Flap Transposition Combined with Amniotic Membrane Transplantation for Treatment of Nonhealing Corneal Ulcers

Abstract

Introduction. The objective was to evaluate the efficacy of active pedicle epithelial flap transposition combined with amniotic membrane transplantation (AMT) in treating nonhealing corneal ulcers. Material and Methods. Eleven patients (11 eyes) with nonhealing corneal ulcer who underwent the combined surgery were included. Postoperatively, ulcer healing time was detected by corneal fluorescein staining. Visual acuity, intraocular pressure, surgical complications, and recurrence were recorded. Corneal status was inspected by the laser scanning confocal microscopy and anterior segment optical coherence tomography (AS-OCT). Results. The primary diseases were herpes simplex keratitis (8 eyes), corneal graft ulcer (2 eyes), and Stevens-Johnson syndrome (1 eye). All epithelial flaps were intact following surgery, without shedding or displacement. Mean ulcer healing time was 10.8 ± 3.1 days, with a healing rate of 91%. Vision significantly improved from 1.70 to 0.82 log MAR (P = 0.001). A significant decrease in inflammatory cell infiltration and corneal stromal edema was revealed 2 months postoperatively by confocal microscopy and AS-OCT. Corneal ulcer recurred in 1 eye. None of the patients developed major complications. Conclusion. Active pedicle epithelial flap transposition combined with AMT is a simple and effective treatment for nonhealing corneal ulcers.

Visual Acuity and Number of Amniotic Membrane Layers as Indicators of Efficacy in Amniotic Membrane Transplantation for Corneal Ulcers: A Multicenter Study

“…Several studies have described the benefits of AMTs as a treatment for various ocular surface pathologies [ 14 , 34 , 35 , 55 ], including NHCUs [ 56 , 57 , 58 ]. However, the diverse etiologies of the ulcers, the small sample sizes, and the adjuvant treatments used or the analysis of the different variables make direct comparisons difficult [ 5 , 6 , 31 , 40 , 42 , 43 ]. Our multicenter study aimed to study a series of indicators in a large sample size, with a special emphasis on VA gain and number of layers.…”

“…NHCUs with an active infection, descemetocele, or perforation were excluded. Furthermore, patients with ulcers due to bullous keratopathy, post-keratoplasty ulcers, rheumatic corneal ulcers, stem cell deficiencies (requiring different surgical techniques), or chemical burns (requiring AMT within two weeks, thus not qualified as an NHCU) were excluded [ 5 , 46 ]. The measurement of ulcers’ width was not standardized at all centers, which is why this parameter was excluded from our study.…”

“…A non-healing corneal ulcer (NHCU) is defined as an ulcer that does not show any indication of complete corneal epithelialization within two weeks despite the administration of proper medical treatment [ 5 ]. It can be caused by multiple conditions such as neurotrophic keratitis, infection, rheumatic disease, eyelid malposition, trauma, and corneal dystrophy [ 5 , 6 ]. NHCUs can progress to descemetoceles or perforations, which is why their rapid treatment is highly recommended.…”

“…NHCUs can progress to descemetoceles or perforations, which is why their rapid treatment is highly recommended. In this regard, amniotic membrane transplantation (AMT) has been suggested as an excellent therapeutic option [ 5 , 6 ].…”

“…Although the usefulness of AMT in treating NHCU has previously been investigated, several questions remain unanswered, especially with regard to VA gain and the number of layers used [ 6 , 31 , 40 , 41 , 42 ]. The current uncertainties may be due to the differences in the etiology of ulcers, insufficient statistical approach, or indicators evaluated [ 5 , 6 , 31 , 40 , 42 , 43 ]. In order to address these limitations, the present multicenter study sought to assess the efficacy of AMT in a large sample of patients with NHCUs while considering the VA gain and number of layers used.…”