Amniotic Membrane as a Main Component in Treatments Supporting Healing and Patch Grafts in Corneal Melting and Perforations

Abstract

Purpose. To report on surgical approaches using amniotic membrane applications and patch grafts in corneal melting and perforations. Anatomical and functional results, including advantages and disadvantages of the interventions, will also be explored. Methods. A five-year retrospective analysis of 189 surgical treatments involving corneal melting with perforation was performed. In one evaluated treatment type, a graft of amniotic membrane, often folded one to three times, was sutured with the epithelial side facing the previously mechanically debrided corneal tissue. A larger monolayer amniotic patch was then sutured, with the epithelial side facing the top of the first membrane, to the perilimbal conjunctiva. For corneal patch grafts, the size-fitting technique of graft trephination was applied, and the donor-recipient junctions were sewn with interrupted sutures. All the procedures were evaluated, noting outcomes and complications of surgery, preoperative and postoperative visual acuities, postoperative intraocular pressures, graft rejection, and other late comorbidities and complications. Results. We performed 119 amniotic membrane applications (63%) and 70 corneal patch grafts (37%). Anatomical reconstruction of the anterior chamber was achieved in 157 eyes, of which 102 eyes (86%) received an amniotic membrane and 55 eyes (79%) were treated with the patch graft technique. In 63 eyes (33%), more than one amnion or graft treatment was necessary to close the corneal perforation. Conclusions. The success of medical and surgical management depends on the cause of corneal melting, and amniotic membrane applications often require further intervention; nevertheless, patch grafts deliver better tectonic reconstruction than amniotic membrane alone.

Nano-Scale Modifications of Amniotic Membrane Induced by UV and Antibiotic Treatment: Histological, AFM and FTIR Spectroscopy Evidence

“…In the patch or overlay technique, the AM is placed temporarily on the ocular surface, acting as biological bandage, but not being integrated into the host. In this case, the epithelium is expected to grow underneath rather than over the top, and the AM will disassociate from the ocular surface after a certain time [ 32 ]. Regardless the surgical technique employed, topical antibiotic application is required in order to eliminate the risk of infectious keratitis.…”

Pericardium Patch Graft for Severe Corneal Wound Burn

“…Moreover, it may be difficult to fold and stabilize the slippery layers of the AM. 5 Tectonic full thickness or lamellar corneal graft is an alternative option. Nonetheless, irregular astigmatism 7 in this patient's only eye as well as risk of graft rejection and suture-related complications were a concern in our case, in particular because he had learning difficulty with a history of eye rubbing.…”

“…Corneal wound burn is an uncommon complication of phacoemulsification surgery 1 that can result in further complications including high astigmatism, 2 corneal edema, and wound leak, 2 and endophthalmitis. 3 Several methods of treating corneal deficit and persistent wound leak have been described in the literature including cyanoacrylate or fibrin glue, 4 amniotic membrane (AM) patch graft, 5 ethanol or glycerol preserved corneal patch graft, 6 tectonic full thickness or lamellar corneal graft, 7 and conjunctival flap. 8 This case documents a previously unreported use of Tutoplast ® (Innovative Ophthalmic Products, Inc., Costa Mesa, CA, USA) human pericardium patch graft in managing persistent wound leak and corneal gaping wound after phacoemulsification and lens implant surgery.…”

Delayed Re-epithelialization After Epithelium-Off Crosslinking: Predictors and Impact on Keratoconus Progression

“…In one case, debridement was performed for redundant or loose epithelial margins. Additional surgical procedures were not needed in our cohort of patients (11,12).…”