Amniotic Membrane Transplantation for Spontaneous Corneal Perforation in a Case Of Rheumatoid Arthritis

Purpose. To report the use of infliximab in the rapid stabilization of a case of progressive, bilateral rheumatoid peripheral ulcerative keratitis (PUK) that failed to respond to conventional immunosuppressive therapy.Methods. A single interventional case report.Results. A patient with rheumatoid arthritis presented with bilateral PUK following a 2-month history of ocular discomfort and redness. His systemic prednisolone (PDN) and methotrexate (MTX) were increased and, despite an initial favorable response, bilateral recurrent corneal perforations ensued. Both eyes underwent cyanoacrylate glue repair, amniotic membrane transplantation (AMT), and penetrating keratoplasty (PKP). Recurrence of the disease and bilateral perforations of the second PKP in both eyes prompted administration of intravenous infliximab immediately after the fourth PKP. The disease activity rapidly settled in both eyes, and at eighteen-month followup, after 12 infliximab infusions, the PUK remains quiescent with no further graft thinning or perforation.Conclusion. Infliximab can be used to arrest the progression of severe bilateral rheumatoid PUK in cases that are refractory to conventional treatment.

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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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Multilayer amniotic membrane transplantation for bacterial keratitis with corneal perforation after hyperopic photorefractive keratectomy

Journal of Cataract & Refractive Surgery ◽

10.1016/j.jcrs.2007.04.040 ◽

2007 ◽

Vol 33 (9) ◽

pp. 1636-1640 ◽

Cited By ~ 14

Author(s):

Mario Nubile ◽

Paolo Carpineto ◽

Manuela Lanzini ◽

Marco Ciancaglini ◽

Eduardo Zuppardi ◽

...

Keyword(s):

Amniotic Membrane ◽

Photorefractive Keratectomy ◽

Amniotic Membrane Transplantation ◽

Bacterial Keratitis ◽

Corneal Perforation

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Lamellar Keratoplasty Combined with Amniotic Membrane Transplantation for the Treatment of Corneal Perforations: A Clinical and In Vivo Confocal Microscopy Study

BioMed Research International ◽

10.1155/2020/7403842 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Lan Ke ◽

Dan Shen ◽

Haoyu Wang ◽

Chen Qiao ◽

Qingyan Zeng

Keyword(s):

Confocal Microscopy ◽

Amniotic Membrane ◽

Corneal Stroma ◽

Lamellar Keratoplasty ◽

Amniotic Membrane Transplantation ◽

Corneal Perforation ◽

In Vivo Confocal Microscopy ◽

The Mean

Purpose. To evaluate the clinical and in vivo confocal microscopy outcome of lamellar keratoplasty combined with amniotic membrane transplantation for the treatment of corneal perforations. Methods. In this retrospective, noncomparative, and interventional case series, 13 eyes of 13 patients with corneal perforation were included. All eyes were treated with lamellar keratoplasty combined with amniotic membrane transplantation for corneal reconstruction. Age, underlying etiology, location, size of corneal ulcer, size of corneal perforation, hospitalization days and follow-up time, and corneal confocal microscopy were investigated. Aqueous leakage, anterior chamber formation, epithelial healing time, and visual acuity (VA) were monitored after operation. Results. The cause of corneal perforation (n = 13) was classified as infectious (n = 1) and noninfectious (n = 12). Most of the locations of corneal perforation were paracentral, and 2 of them were center. The anterior chambers were formed without aqueous leakage and other complications at postoperative day. The mean time of regained a smooth corneal surface was 7.5 ± 2.9 (ranging from 4 to 14) days. The mean hospitalization day was 13.1 ± 4.5 (ranging from 7 to 22) days. The mean follow-up time is 22.5 ± 14.5 (ranging from 4 to 43) months. The AM appeared as a high-reflective reflection in the corneal stroma after surgery about half a year and is almost transparent at about one year. Corneal stroma-derived cells were populated in the AM at about 1 month, increased at 2 months, and almost not obviously at 20 months postoperatively. The size and density of endothelial cells were stable after 1 year near the perforation site. The VA improved to varying degrees in 9 eyes, remained unchanged in 2 eyes, and decreased in 2 eyes. One eye recurrence and no side effects occurred during the follow-up time. Conclusion. Lamellar keratoplasty combined with amniotic membrane transplantation may be an alternative, safe, and effective surgical therapy in the treatment of corneal perforations in the absence of a fresh donor cornea. We recommend this surgery to treat with the size of corneal perforation of <4 mm in diameter no matter peripheral or central corneal perforation, especially who had immune-related diseases.

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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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Case Series of Perforated Keratomycosis after Laser-Assisted In Situ Keratomileusis

Case Reports in Ophthalmological Medicine ◽

10.1155/2020/7237903 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Taher Eleiwa ◽

Eyup Ozcan ◽

Samar Abdelrahman ◽

Omar Solyman ◽

Abdelrahman M. Elhusseiny ◽

...

Keyword(s):

Visual Acuity ◽

Amniotic Membrane ◽

Symptom Onset ◽

Complete Resolution ◽

Penetrating Keratoplasty ◽

Case Series ◽

Amniotic Membrane Transplantation ◽

Corneal Perforation ◽

The Mean

Background. Fungal keratitis is an extremely rare complication of laser vision correction resulting in poor visual outcomes. Amniotic membrane transplantation should be kept in mind in eyes with corneal perforation prior to penetrating keratoplasty. Aim. To assess the outcomes of multilayered fresh amniotic membrane transplantation (MLF-AMT) in patients with severe keratomycosis after laser-assisted in situ keratomileusis (LASIK). Study design. Hospital-based prospective interventional case series. Methods. Five eyes of 5 patients were included in the study. All cases underwent microbiological scrapings from residual bed and intrastromal injections of amphotericin (50 mcg/mL), with flap amputation if needed, followed by topical 5% natamycin and 0.15% amphotericin. MLF-AMT was performed after corneal perforation. Later, penetrating keratoplasty (PK) was performed when corneal opacity compromised visual acuity. The outcome measures were complete resolution of infection, corneal graft survival, and best-corrected visual acuity (BCVA). Results. The mean age of patients was 22±1.2 years with 4/5 (80%) were females. The mean interval between LASIK and symptom onset was 8.8±1 day, and the mean interval between symptom onset and referral was 14±1.4 days. Potassium hydroxide (KOH) smears showed filamentous fungi, and Sabouraud’s medium grew Aspergillus in all cases. Melted flaps were amputated in 4 (80%) cases. MLF-AMT was performed in all cases due to corneal perforation after a mean time of 12.4±1.2 days of antifungals. In all cases, complete resolution of infection was seen 26±1.8 days after MLF-AMT, and optical PK was done at a mean of 2.4 months later. No postoperative complications after MLF-AMT or PK were observed, with a 0% incidence of corneal graft rejection, and a final BCVA ranged from 20/20 to 20/80 after a mean follow-up of 14±1.1 months. Conclusion. MLF-AMT is a safe and valid option to manage corneal perforation during keratmycosis treatment to avoid emergency therapeutic keratoplasty.

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