Self-Retained Amniotic Membrane Combined With Antiviral Therapy for Herpetic Epithelial Keratitis

Abstract

PURPOSE To evaluate the therapeutic benefit of self-retained cryopreserved amniotic membrane (CAM) in conjunction with oral antiviral therapy in herpetic epithelial keratitis. METHODS Retrospective review of 4 patients with primary (1 eye) and recurrent (3 eyes) unilateral herpetic epithelial keratitis treated with CAM through the placement of PROKERA® Slim (Bio-Tissue, Miami, FL) (PKS) in conjunction with oral acyclovir. Their symptoms, conjunctival inflammation, corneal staining, and visual acuity were compared before and after treatment. RESULTS The herpetic epithelial keratitis presented as dendritic (3 eyes) and geographic (1 eye) epithelial lesions. Following epithelial debridement and placement of PKS for 5 ± 3.7 days, all patients reported a significant relief of symptoms, rapid corneal epithelization, and reduction of ocular surface inflammation. The visual acuity was also improved in all eyes from 0.7 ± 0.7 to 0.4 ± 0.7 logMAR (P = 0.2). They remained symptom-free during a follow-up period of 2.7 to 50.8 (20.3 ± 21.7) months. CONCLUSIONS PKS in conjunction with oral acyclovir facilitates the ease of early intervention to accelerate restoration of a normal corneal epithelium in herpetic epithelial keratitis.

<p>Self-Retained Cryopreserved Amniotic Membrane for the Management of Corneal Ulcers</p>

“…Overall, these findings support the use of AM in promoting complete epithelialization of corneal ulcers caused by underlying NK. Three retrospective case series [15][16][17] have reported findings regarding the use of self-retained cAM for the treatment of corneal ulcers. Cheng and Tseng found 4 herpetic corneal ulcers underwent rapid corneal epithelization within 5 ± 4 days of PKS placement along with reduced ocular surface inflammation and improved VA during 3-51 months of follow-up.…”

“…Cheng and Tseng found 4 herpetic corneal ulcers underwent rapid corneal epithelization within 5 ± 4 days of PKS placement along with reduced ocular surface inflammation and improved VA during 3-51 months of follow-up. 16 In another short-term study, Suri et al described how 73% (8/11) of corneal ulcers healed following PROKERA ® placement despite failure to heal with prior use of punctal plugs (n = 5), BCL (n = 4), and tarsorrhaphy (n = 2); 15 remarkably, one eye with descemetocele re-epithelialized and formed an anterior chamber following treatment with PROKERA ® despite failure to heal with BCL. 15 In a case series involving corneal ulcers with bacterial keratitis, Sheha et al found 2 of 3 corneal ulcers healed in 14 and 23 days.…”

“…[12][13][14] While AMT with sutures has been widely reported for the treatment of corneal ulcers, few studies have assessed the use of self-retained cryopreserved AM (cAM). [15][16][17][18] Therefore, the purpose of this study was to assess the clinical outcomes following the treatment of corneal ulcers with self-retained cAM.…”

Pathogenesis of herpes simplex keratitis: The host cell response and ocular surface sequelae to infection and inflammation

“…Amniotic membrane has anti-inflammatory effects on activated neutrophils, lymphocytes and macrophages, reduces levels of inflammatory cytokines, IL-2 and IFN-γ, and may release nerve growth factor, allowing for improved wound healing. 132…”

Self-retained cryopreserved amniotic membrane for treating severe corneal ulcers: a comparative, retrospective control study

“…Of these choices, AM not only delivers steroid-sparing anti-inflammatory, anti-scarring, and pro-regenerative properties 2,3 but also provides a mechanical protective barrier effect. Suture of cryopreserved AM in the operating room [4][5][6] or placement of self-retained cryopreserved AM in-office [7][8][9][10] has successfully treated corneal ulcers of various etiologies. However, comparative analysis between self-retained AM and a control group has not been performed.…”