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

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 was10.8±3.1days, 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.

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Sutureless “Contact Lens Sandwich” Technique for Amniotic Membrane Therapy of Central Corneal Ulcers

European Journal of Ophthalmology ◽

10.1177/11206721211049093 ◽

2021 ◽

pp. 112067212110490

Author(s):

Saverio V. Luccarelli ◽

Edoardo Villani ◽

Stefano Lucentini ◽

Francesco Bonsignore ◽

Matteo Sacchi ◽

...

Keyword(s):

Amniotic Membrane ◽

Contact Lens ◽

Low Cost ◽

Healing Time ◽

Amniotic Membrane Transplantation ◽

Recurrence Rates ◽

Sandwich Technique ◽

Corneal Ulcers ◽

Bandage Contact Lens ◽

Ring Complex

Purpose To describe a new technique for sutureless and glue-free amniotic membrane transplantation (AMT) and to investigate its effectiveness to treat corneal persistent epithelial defects (PEDs), compared to bandage contact lens (BCL) application alone. Methods We performed AMT with “contact lens sandwich technique” (CLS-AMT) in 8 consecutive patients with central/para-central (up to 4.00 mm from the geometrical centre) PED/ulceration and we retrospectively compared the results with 11 BCL procedures. Results The procedures were performed successfully with no complications. CLS-AMT showed significantly shorter healing time than BCL (24.0 ± 19.1 vs 42.9 ± 14.6 days; P < 0.05, Mann-Whitney test). Recurrence rates were 12% and 27% for CLS-AMT and BCL, respectively. Conclusion CLS-AMT technique, based on the suction effect due to the superposition of a bandage contact lens on the AM-ring complex, represents a quick, low cost, easy to perform and nearly non-invasive AMT technique. This approach is able to provide adequate fixation of AM, and it seems to be a safe and effective treatment for patients with PEDs.

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A Challenging Management of Pseudomonas Perforated Corneal Ulcer with Multilayer Amniotic Membrane Transplantation and Pericardial Patch Graft in Pediatric Patient

Vision Science and Eye Health Journal ◽

10.20473/vsehj.v1i1.2021.22-27 ◽

2021 ◽

Vol 1 (1) ◽

pp. 22

Author(s):

Nabilah Afifah ◽

Herwindo Dicky Putranto ◽

Lely Retno Wulandari

Keyword(s):

Pseudomonas Aeruginosa ◽

Amniotic Membrane ◽

Corneal Ulcer ◽

Definitive Treatment ◽

Amniotic Membrane Transplantation ◽

Pericardial Patch ◽

Corneal Perforation ◽

Corneal Ulcers ◽

Patch Graft ◽

The Right

Introduction: Pseudomonas aeruginosa (P. aeruginosa) is the leading cause of corneal ulcers in children 0 to 3 years of age compared to children in general. Case presentation: A two-months-old infant presented with whitish patches on the right eye two days before admission. A central corneal ulcer with a size of 7-mm x 7-mm accompanied by corneal thinning and melting was shown on the right cornea. It is was surrounded by greyish white creamy infiltrates. Corneal scraping showed Pseudomonas aeruginosa specimens. The cornea became perforate and crystalline lens extrusion was found at the day after intravenous ceftriaxone, levofloxacin eye drop, and cefazoline fortified eye drop administering. It might be caused by bacterial elastase and toxin which contributed to corneal damage. The patient was underwent a multilayer Amniotic Membrane Transplantation (AMT) combined with a pericardial patch graft due to corneal perforation. Two months post-AMT and pericardial patch graft the corneal perforation became entirely heal due to multilayer AMT, despite lysis of the pericardial patch graft. Corneal scar formation and reduction of vitreous opacity in ultrasound examination were shown. The patient was planned to undergo keratoplasty. Conclusions: Corneal ulcers due to Pseudomonas aeruginosa are highly destructive. The levels of infection, diagnostic, and therapeutic are still problems in pediatric patients. Lens extrusion and lysis of the pericardial patch graft are examples in this case. Keratoplasty is the definitive treatment for corneal ulcers with perforation; however, multilayer AMT combined with pericardial patch graft can be used as an alternative therapy to accelerate wound healing, reduce inflammation, and maintain the integrity of the eyeball.

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Amniotic membrane transplantation for infectious corneal ulcer treatment: a cohort retrospective study

Medical Journal of Indonesia ◽

10.13181/mji.oa.203849 ◽

2020 ◽

Vol 29 (4) ◽

pp. 379-85

Author(s):

Vega Casalita ◽

Rina La Distia Nora ◽

Lukman Edwar ◽

Made Susiyanti ◽

Ratna Sitompul

Keyword(s):

Amniotic Membrane ◽

Corneal Ulcer ◽

Treatment Success ◽

Healing Time ◽

Complete Healing ◽

Amniotic Membrane Transplantation ◽

Corneal Wound ◽

Uncorrected Visual Acuity ◽

Snellen Chart ◽

Corneal Scar

BACKGROUND Corneal ulcer is one of the most common causes of corneal blindness. This study aimed to describe the outcomes of amniotic membrane transplantation (AMT) in patients with infectious corneal ulcer. METHODS A retrospective cohort study based on medical records of patients who underwent an adjuvant AMT procedure over a 2-year period (2015–2017) was conducted at Cipto Mangunkusumo Hospital Jakarta. Uncorrected visual acuity (UCVA) was measured with the Snellen chart. Treatment success was marked by complete healing (disappearance of corneal infiltrates, epithelial defect closure, and corneal scar formation). Healing time was the duration from AMT surgery to complete healing. RESULTS 50 cases of infectious corneal ulcer, 12 of which had perforation were included. Gram-positive cocci (18%), gram-negative rods (14%), fungi (4%), and Acanthamoeba (2%) were isolated from culture specimens. Successful results were observed in 90% of cases (20/21 moderate cases and 25/29 severe cases). Healing time was 21 (14–63) days in moderate cases and 28 (14–90) days in severe cases. Baseline UCVA improved from 2.48 (0.22–2.80) logMAR to 1.30 (0–2.80) logMAR within 3–4 weeks postoperatively and to 0.94 (0–2.80) logMAR at the last follow-up. Post-AMT complications included recurrent perforation in 4 eyes, persistent epithelial defects in 2 eyes, amniotic membrane infection in 1 eye, and membrane retraction in 1 eye. CONCLUSIONS AMT was successfully used to treat moderate and severe infectious corneal ulcer, particularly in nonresponsive and some perforated cases. AMT provides biochemical and mechanical support for corneal wound healing with good visual outcomes.

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Amniotic membrane transplantation in a patient with an impending perforated corneal ulcer caused by Streptococcus mitis: a case report

10.21203/rs.2.434/v2 ◽

2019 ◽

Author(s):

Fang-Chi Hsiao ◽

Yaa-Jyuhn James Meir ◽

Lung-Kun Yeh ◽

Hsin-Yuan Tan ◽

Ching-Hsi Hsiao ◽

...

Keyword(s):

Amniotic Membrane ◽

Corneal Ulcer ◽

Amniotic Membrane Transplantation ◽

Streptococcus Mitis ◽

Continuous Administration ◽

Corneal Ulcers ◽

Corneal Erosion ◽

Corneal Scraping ◽

The Right ◽

Viridans Group Streptococci

Abstract Background: Streptococcus mitis (S. mitis) belongs to the viridans group streptococci, which is rarely isolated as a causative pathogen of corneal ulcers. When S. mitis causes keratitis, penetrating keratoplasty (PK) might be necessary. Herein, we demonstrated that amniotic membrane transplantation (AMT) may be an easier procedure with acceptable outcomes and with fewer complications. Case presentation: A 63-year-old female presented with a right persistent corneal ulcer that she had suffered from for the past nine months. The culture of a corneal scraping yielded S. mitis. The right eye descemetocele decreased from 3 mm in diameter to 0.8 mm in diameter after the continuous administration of topical vancomycin and ceftriaxone for two weeks. Due to the slow healing, AMT was performed. Her corneal erosion healed and gradually became clear. Her visual acuity recovered from initially counting fingers to 20/200 17 months after AMT. Conclusion: This unusual case illustrated that antibiotics plus AMT may be an effective alternative treatment instead of PK to promote epithelialization and to reduce inflammation in corneas complicated by S. mitis keratitis.

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