Case Report: Use of Amniotic Membrane for Tectonic Repair of Peripheral Ulcerative Keratitis With Corneal Perforation

Eslami, Maryam; Benito-Pascual, Blanca; Goolam, Saadiah; Trinh, Tanya; Moloney, Greg

doi:10.3389/fmed.2022.836873

Cited by 5 publications

(7 citation statements)

References 9 publications

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“…Hoffman et al [14]. reported a primary success rate of 11/12(92%) as compared to 11/15(73.33%) in the present study Similar results were shown by Eslami M et al [33]. who reported successful use of multilayered amniotic membrane transplantation for the treatment of corneal ulceration and perforation.…”

Section: Recurrencesupporting

confidence: 89%

Amniotic Membrane Transplantation-A Surgical Alternative in Peripheral Ulcerative Keratitis

Thatte,

Batra,

Nandal

2023

J Opht Res Rev Rep

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Introduction: Peripheral ulcerative keratitis (PUK) is a group of inflammatory corneal ulcers with stromal thinning and peripheral localization. It begins with immune cellular infiltrates in the juxtalimbal cornea, followed by a crescent-shaped ulcer that appears parallel to the limbus. Medical management includes intense lubrication, antibiotics, along with topical and systemic steroids and immunosuppressants. Definitive surgical management is lamellar patch or penetrating corneal graft. Amniotic membrane has wide array of biological properties, including anti-inflammatory, anti-bacterial, anti-angiogenic, antifibrotic, healing properties hence can be used as an alternative to keratoplasty. Material and Methods: This mono institutional observational retrospective study was conducted on 15 eyes of 15 patients having PUK in a tertiary health care centre. Patients underwent single-layered amniotic membrane transplantation (AMT) in case of corneal thinning involving <1/2 corneal stroma, multi-layered or rolled AMT in cases of corneal thinning involving >1/2 corneal stroma or with moderate to large perforations along with systemic steroids and immunosuppression. Results: All 15 Patients (100%) initially had symptomatic relief,2 patients (13.33%) underwent repeat AMT (86%success rate), 2 failures were noted, out of which 1 patient (6.67%) underwent corneal patch graft while 1 patient (6.67%) underwent large penetrating keratoplasty which failed and landed in Phthisis. Conclusion: AMT is a safe and effective alternative for the surgical management of PUK in combination with local and systemic immunosuppressive therapy. A close collaboration between the ophthalmologist and the physician is mandatory to prevent corneal perforation and decrease patient morbidity and risk of mortality

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Section: Recurrencesupporting

confidence: 89%

Amniotic Membrane Transplantation-A Surgical Alternative in Peripheral Ulcerative Keratitis

Thatte,

Batra,

Nandal

2023

J Opht Res Rev Rep

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“…In the second case, Snellen's visual acuity at the 1-month and 4month postoperative visit was 6/90 in RE (with cataract) and 6/9 in LE with normal intraocular pressures and a quiet ocular surface. 12 The relative ease of availability of AM compared to donor cornea makes this an attractive choice for the management of corneal defects. it may be an appropriate temporizing measure to allow for an uninflamed and quiet eye prior to donor corneal graft transplantation, thereby increasing success for visual rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

“…it may be an appropriate temporizing measure to allow for an uninflamed and quiet eye prior to donor corneal graft transplantation, thereby increasing success for visual rehabilitation. 12 There is no absolute perforation size cut-off for the use of AM transplantation. It may be difficult to pack and close large perforation defects and restore the globe's integrity.…”

Section: Discussionmentioning

confidence: 99%

Multilayered-Amniotic Membrane Transplantation in Gunshot Powder Injury: A Case Report

Amanda,

Havriza Vitresia

2024

Bioscmed

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Background: Amniotic membrane transplantation has been widely used to repair various ocular surface conditions, including inflammatory, infectious, traumatic, and neoplastic conditions, with satisfactory results. a case of a 34-year-old male hit by a gunpowder explosion. Case presentation: We reported a case of a 34-year-old male hit by a gunpowder explosion. The right eye was hyperemic and felt blurry after the incident. On examination of the right eye, visual acuity was 20/150, and foreign bodies and erosion were found in the cornea. The patient planned to do foreign body extraction followed by a multilayered-amniotic membrane transplantation (ML-AMT) procedure. On the first and second day of follow-up, on the right eye, the visual acuity was 1/300, palpebral edema was decreased, and subconjunctival hemorrhage was found. On the cornea, there were ML-AMT and bandage contact lenses. Conclusion: Gunshot powder injury in the eyes is quite rare. The damage that can occur ranges from corneal epithelium abrasion to perforation and rupture of the eyeball. AMT has been successfully used in the management of eye trauma with defects on the ocular surface.

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“…One previous study discussed the role of combined UCP grafting and HAM transplantation in managing corneal perforation or descemetocele in eyes with active keratitis [4]. However, most prior research has emphasized the role of HAM transplantation [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…HAM acts as a graft or temporary patch by promoting corneal epithelialization and preventing stromal inflammation, angiogenesis, and scarring [ 8 ]. Typically, multiple layers of HAM are used to treat deep corneal ulcers or perforations [ 9 ]. However, because of its weak tectonic support, HAM carries the risk of early dissolution or dislocation before the healing of corneal perforation [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Combined umbilical cord patching with amniotic membrane graft for corneal surface reconstruction

Farag¹,

Elmowafi²,

El-Sharkawy³

et al. 2022

Med Hypothesis Discov Innov Ophthalmol

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Background: Umbilical cord patch (UCP) grafts have been successfully used for glaucoma shunt tube coverage and conjunctival surface reconstruction. In recent years, the technique has emerged as a novel alternative for the reconstruction of corneal perforation and descemetocele. This study aimed to evaluate the effectiveness of combined UCP grafting and human amniotic membrane (HAM) transplantation for the management of corneal perforation or descemetocele. Methods: This prospective, non-comparative, interventional case series included nine eyes of nine patients with corneal descemetoceles and 28 eyes of 28 patients with corneal perforations, all in a clinically quiescent state. UCP grafting and HAM transplantation were combined to treat all patients. We re-examined the patients daily throughout the first week, weekly for 1 month, and then monthly for the first 6 months using slit-lamp examination and anterior segment optical coherence tomography. Results: We included 37 eyes with descemetocele or corneal perforation in a clinically quiescent state. The mean (standard deviation) ages of patients with corneal descemetocele and corneal perforation were 56.3 (18.8) years and 54.3 (18.1) years, respectively. The male-to-female ratios in patients with corneal descemetocele and corneal perforation were 56% to 44% and 61% to 39%, respectively. Postoperative corneal thickness increased significantly in eyes with descemetocele compared to preoperative values (P < 0.001). Postoperative best-corrected distance visual acuity improved significantly compared to preoperative values in eyes with descemetocele or corneal perforation (both P < 0.001), with relief of accompanying ocular symptoms. We did not observe any recurrence or complications such as rejection, infection, suture-related problems, or severe inflammation and all had a formed anterior chamber up to the final follow-up visit. Conclusions: Combined UCP grafting and HAM transplantation could be a promising alternative treatment for corneal perforation or descemetocele in clinically quiescent eyes, providing satisfactory reconstruction and functional outcomes. Further studies with robust designs, larger sample sizes, and longer follow-up are needed to verify the efficacy and safety of this modified surgical technique in enhancing vision and restoring anterior segment anatomical integrity in compromised corneas.

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Case Report: Use of Amniotic Membrane for Tectonic Repair of Peripheral Ulcerative Keratitis With Corneal Perforation

Cited by 5 publications

References 9 publications

Amniotic Membrane Transplantation-A Surgical Alternative in Peripheral Ulcerative Keratitis

Amniotic Membrane Transplantation-A Surgical Alternative in Peripheral Ulcerative Keratitis

Multilayered-Amniotic Membrane Transplantation in Gunshot Powder Injury: A Case Report

Combined umbilical cord patching with amniotic membrane graft for corneal surface reconstruction

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