Management of recurrent corneal ulcers: use of amniotic membrane (original) (raw)
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Multilayer amniotic membrane transplantation for reconstruction of deep corneal ulcers
Ophthalmology, 1999
To evaluate the efficacy of multilayer amniotic membrane transplantation for reconstruction of corneal epithelium and stroma in the context of deep corneal ulcers. Prospective, noncomparative, interventional case series. Eleven consecutive patients with deep corneal ulcers refractory to conventional treatment; six patients had herpetic keratitis and five had other forms of neurotrophic keratitis. Multilayer amniotic membrane transplantation with kryopreserved human amniotic membrane. Integrity of corneal epithelium and stroma, opacification, and appearance of grafted membrane during 12 months follow-up. Amniotic membrane transplantation markedly reduced ocular inflammation in all patients. Epithelium healed above all corneal ulcers within 4 weeks and remained stable in 9 of 11 patients for 1 year. Two patients with recurrent epithelial defect suffered from severe neurotrophic keratitis. Following transplantation the amniotic membranes gradually dissolved over a period of 12 months, ...
Multilayer vs. monolayer amniotic membrane transplantation for deep corneal ulcer treatment
Collegium antropologicum
The purpose of the study was to evaluate the efficacy of multilayer amniotic transplantation (AMT) for reconstruction of corneal stroma and epithelium. Corneal ulcer (28) was a consequence of a previous infectious or neurotrophic keratitis. In the first group (17) ulcer was covered with monolayer AM, while in the other group (11) there were two or more layers of AM situated in the ulcer and the whole cornea was covered with AM sheet. Monolayer AMT was successful in 64% while the multilayer AMT success rate was 72%. AM gradually dissolved within 3-6 postoperative weeks. AM transplantation facilitates rapid healing of corneal epithelium, reduces inflammation and stimulates epithelial cell regrowth. In eyes with deep corneal ulcer multilayer technique proved to be better then monolayer procedure.
Transplantation of amniotic membrane in corneal ulcers and persistant epithelial defects
Collegium antropologicum, 2011
Amniotic membrane transplantation (AMT) leads to reduction of inflammatory symptoms and causes faster epithelisation in corneal ulcers and persistant epithelial defect. 21 patients with corneal ulcer (n = 18) or non-healing epithelial defect (n = 3) unresponsive to conventional treatment were included in the study. All patients were treated by AMT. Corneal epithelial cells in patients suffering from corneal ulcer secreted 3.51 +/- 1.79 of IL-1alpha, 64.27 +/- 31.53 pg/mL of TNFalpha and 209.07 +/- 201.82 pg/mL of VEGF. Levels of all 3 investigated cytokines were significantly higher as compared to controls (p < 0.005). Amniotic membranes that were used contained 775.69 +/- 613.98 pg/mL of IL-1alpha, 0.036 +/- 0.033 pg/mL of sTNF and 175.01 +/- 166.63 pg/mL of VEGF-R. Supporting effect of the AMT could be explained by the fact that AM secretes its natural antinflammatory antagonists IL-1ra, sTNF and VEGF-R.
Amniotic Membrane transplantation for corneal surface reconstruction
To evaluate the efficacy of fresh human amniotic membrane for reconstruction in corneal surface diseases. Material and Methods: 28 eyes of 26 patients with corneal surface disorders were evaluated. Indications for AMT included bullous keratopathy (4 eyes), climatic droplet keratopathy (3 eyes), Steven Johnson syndrome (7 eyes), chemical injury (3 eyes), corneal ulcer (7 eyes), band keratopathy (2 eyes) and shield ulcers (2 eyes). Fresh amniotic membrane was used in all the cases. Result: The age range was from 18-65 years, out of which 15 were males and 11 were females. Success was noted in75% (21/28 eyes) with very few complications in an average follow up period of 6 months. The mean epithelisation time varied from 2-2.4 weeks. Conclusion: Fresh amniotic membrane can reduce inflammation, promote epithelisation and decrease in various corneal surface disorders.
European Journal of Ophthalmology, 2013
Having in mind the healing properties of AM we investigated the efficacy of AMT in persistent epithelial defect (PED) on the corneal graft. 80 corneal grafts were prospectively followed up for presence of PED 10 months after surgery. PED was detected in 12 cases (15%) having surgery for: rejected graft (n=4), keratoconus (n=3), keratoconus following PK on a second eye (n=3), corneal perforation (n=1) and Stevens-Johnson keratopathy (n=1). Epithelial defect (ED) developed 14±7 days after surgery in 10 cases and 1,5 month in other two. All patients were primarily conservatively treated with subconjuctival steroids and artificial tears for 10 days and systemic steroid therapy if needed after, until the period of 2 weeks. 4 patients were healed. Since ED was unresponsive to all previous treatments for more then 2 weeks, one layer of AM was placed on the corneal lesion in 5 patients, and in 3 cases of deep PED several layers of AM were placed. Healing of the defect was obtained in 7/8 (87.5%) eyes. In 1 patient second AM transplantation was necessary. Mean epithelization time was 2 weeks (range 1-3 weeks) in monolayer and 3 weeks (range 2-4 weeks) for multilayer cases. 5 out of 8 patients retained the same best corrected visual acuity (BCVA) while 3/8 patients improved their vision more than 2 lines. Preoperative corneal thickness of 255±40 mm increased to 455±90 mm. AM transplantation facilitates healing of corneal epithelium. PED on the corneal graft unresponsive to conventional treatment can be effectively cured when covered with one or more amniotic membrane layers.
Amniotic Membrane Inlay and Overlay Grafting for Corneal Epithelial Defects and Stromal Ulcers
Archives of Ophthalmology, 2001
Objectives: To determine the effect of amniotic membrane transplantation (AMT) on persistent corneal epithelial defects (PEDs) and to compare the efficacy between inlay and overlay techniques. Methods: Thirty patients (30 eyes) underwent AMT for PED. The use of AMT was restricted to patients in whom all previous measures, including bandage contact lens and tarsorrhaphy, had failed. The amniotic membrane was placed on the surface of the cornea in overlay (group A) or inlay (group B) fashion. The PED healed after the first AMT in 21 eyes (70%) within an average of 25.5 days after surgery and recurred in 6 eyes (29%). Among the 22 eyes treated with an overlay AMT (group A), the PED healed after the first AMT in 14 eyes (64%) within an average of 24.5 days (REPRINTED) ARCH
Amniotic Membrane Transplantation for Keratitis
Journal of IMAB - Annual Proceeding (Scientific Papers), 2015
Keratitis without proper management tends to perforate the cornea, resulting in severe adverse consequences. In recent studies, amniotic membrane is reported to have anti-inflammatory effect and promote wound healing of corneal ulcer. Purpose: To report on the efficacy of permanent amniotic membrane transplantation (AMT) in the treatment of keratitis. Case report: A 58-year-old man with severe keratitis in both eyes caused by long term administration of topical anesthetic (alcaine) for electric ophthalmia. Single layer of amniotic membrane (AM) was placed on the defect and secured to the limbus with interrupted 10-0 nylon sutures. A bandage contact lens was applied on the AM. Postoperative medication included topical antibiotic, artificial tears and mydriatic. Three months later corticosteroid was included. There was an immediate decrease of patient's pain after surgery. Complete epithelialization was noted after 1 month. Conclusion: AMT is an alternative adjunctive method of treatment of keratitis; it promotes epithelialization process, decreased inflammation, corneal haze and neovascularization.
Amniotic membrane transplantation for ocular surface pathology: long-term results
Transplantation Proceedings, 2003
Amniotic membrane transplantation has been used for Ͼ90 years for cutaneous and mucous lesions for regeneration of tissues. In recent years its effectiveness has been demonstrated in the treatment of diseases of the ocular surface. We present our experience with 53 amniotic membrane transplantations for different ocular pathologies with two different forms of implantation. The 53 cases were divided into three groups according to pathology and type of implant. Group 1 included 24 eyes with amniotic membrane grafts after resection of extensive conjunctival lesions. Group 2 included 19 eyes with amniotic membrane grafts for corneal pathology, and group 3 consisted of 10 eyes with amniotic membrane patches for corneal epithelial defects without ulceration. No intra-or postoperative complications were observed during an average follow-up period of 32 months (24 -48 months). Group 1 demonstrated rapid healing of the lesions with minimal scarring in all cases. In group 2 a favorable response was observed in 16 of 19 cases. In group 3 complete healing was achieved in only 3 of 10 cases, and the time for which the graft remained was related to the success of the treatment. The primary intention was to achieve prolonged fixation of the implant. Finally, amniotic membrane transplantation is a safe and effective technique for the treatment of different pathologies of the ocular surface. After the resection of extensive conjunctival lesions it is currently the preferred treatment. In corneal pathology, it represents an additional therapeutic alternative when conservative medical treatments fail.