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Pho Nguyen, Ramya Swamy, Kelly Rue, J Heur, Samuel Yiu; Self-retained amniotic membrane for high-risk penetrating keratoplasty - one-year results. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3075.
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To evaluate the role of self-retained cryopreserved human amniotic membrane (hAM) in penetrating keratoplasty (PKP) graft survival.
A retrospective noncomparative interventional case series of 58 cases of high-risk PKP with concurrent placement of a self-retained cryopreserved hAM device (ProKera®) at a tertiary eye center from January 2009 to July 2010. Outcome measure was graft survival. All surgeries were performed by one surgeon (SCY).
Average age was 66.7 ± 17.2 years and 54% were males. 51 eye were pseudophakic and one aphakic. 27 eyes were glaucomatous; 24 of these had glaucoma drainage implants and 2 had endocyclophotocoagulation performed. 12 patients had PKP for the first time and 46 had repeat PKP (average number of prior PKP 1.63 ± 1.1, range: 1-5). High-risk factors included repeat PKP (79.3%), corneal neovascularization (51.7%), preexisting glaucoma (46.6%), and anterior synechiae (37.9%). Both First Transplant and Repeat Transplant groups had similar survival rates until 6 months after transplant. At year 1, the First Transplant group appeared to have better survival (67%), compared to that of the Repeat Transplant (43%). This advantage, however, did not reach statistical significance (hazard ratio 0.562, log-rank test p = 0.207). Eyes with 3+ high-risk factors had higher failure (odds ratio = 5.81, p = 0.003).
Compared to literature, the benefits of hAM in prolongation of graft survival were indeterminate in our study. However, this study has many limitations, e.g. retrospective study of a high-risk population with lack of control and many confounders. Further studies are recommended to provide definitive information on objective and subjective outcomes.
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