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

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

10.21203/rs.2.434/v3 ◽

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

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

Journal of Ophthalmology ◽

10.1155/2016/5742346 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7

Author(s):

Ting Zhang ◽

Yuexin Wang ◽

Yanni Jia ◽

Dongle Liu ◽

Suxia Li ◽

...

Keyword(s):

Confocal Microscopy ◽

Amniotic Membrane ◽

Ulcer Healing ◽

Laser Scanning ◽

Corneal Ulcer ◽

Anterior Segment ◽

Healing Time ◽

Stevens Johnson Syndrome ◽

Amniotic Membrane Transplantation ◽

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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Amniotic Membrane Transplantation Associated with Conjunctival Peritomy in the Management of Mooren's Ulcer: A Case Report

European Journal of Ophthalmology ◽

10.1177/112067210501500217 ◽

2005 ◽

Vol 15 (2) ◽

pp. 274-276 ◽

Cited By ~ 9

Author(s):

A. Lambiase ◽

M. Sacchetti ◽

R. Sgrulletta ◽

M. Coassin ◽

S. Bonini

Keyword(s):

Amniotic Membrane ◽

Signs And Symptoms ◽

Central Hole ◽

Amniotic Membrane Transplantation ◽

Corneal Perforation ◽

Mooren’S Ulcer ◽

Progression Of Disease ◽

The Right ◽

Corneal Infiltrates ◽

Mooren's Ulcer

Purpose To report the association of conjunctival peritomy with amniotic membrane transplantation (AMT) at the limbus with the exclusion of the central cornea in order to preserve visual function in one case of bilateral Mooren's ulcer. Methods A 36-year-old man with bilateral Mooren's ulcer was unresponsive to conventional therapy. Surgical procedure was performed on his right eye, at impending risk of corneal perforation. A 20 × 20 mm piece of amniotic membrane (AM) was prepared by performing a central hole of 7.5 mm diameter with a manual trephine. A 360° conjunctival peritomy was performed and the AM was placed with the epithelium side facing up and the central hole was sutured on the paracentral cornea. Results Two weeks after surgery, while the right eye showed improvement of signs and symptoms and unchanged best-corrected visual acuity (BCVA), the left eye showed a peripheral corneal perforation with prolapsed iris that required conjunctival flap. At 7 months of follow-up, the right eye showed no ocular inflammation, a reduction of the lipid-like peripheral corneal infiltrates, an increased stromal thickness, and an unchanged BCVA. The progression of corneal thinning in the left eye led the authors to perform AMT (as described) in the left eye as well. Five months after the AMT in the left eye, neither eye shows signs of disease progression, and neither requires further therapy. Conclusions Conjunctival peritomy associated with AMT may be an alternative surgical approach in the management of Mooren's ulcers to control the inflammation and the progression of disease.

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Comparison of amniotic membrane transplantation with and without cultured limbal epithelium for persistent corneal ulcers

Biotechnology & Biotechnological Equipment ◽

10.1080/13102818.2021.1924860 ◽

2021 ◽

Vol 35 (1) ◽

pp. 739-745

Author(s):

Rozaliya Hristova ◽

Yani Zdravkov ◽

Georgi Markov ◽

Davide Borroni ◽

Alexander Oscar ◽

...

Keyword(s):

Amniotic Membrane ◽

Amniotic Membrane Transplantation ◽

Corneal Ulcers ◽

Limbal Epithelium

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Role of multilayered amniotic membrane transplantation for the treatment of resistant corneal ulcers in North India

International Ophthalmology ◽

10.1007/s10792-013-9834-3 ◽

2013 ◽

Vol 34 (3) ◽

pp. 485-491 ◽

Cited By ~ 8

Author(s):

Shalini Mohan ◽

Ina Budhiraja ◽

Amit Saxena ◽

Perwez Khan ◽

S. K. Sachan

Keyword(s):

Amniotic Membrane ◽

North India ◽

Amniotic Membrane Transplantation ◽

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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