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T. Liu, S. Khashabi, S. Yiu; Use of PROKERA® in High-Risk Corneal Transplants: Initial Results. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1134.
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Amniotic membranes have been used in ophthalmology for their anti-inflammatory properties. We explore the use of sutureless and adhesiveless amniotic membrane devices (ProKera, Bio-Tissue, Inc., Miami, FL) as an adjunct in patients with penetrating keratoplasty at high risk for postoperative (PO) inflammation, graft rejection, graft failure, or delayed epithelialization.
We performed a retrospective review of 33 patients who underwent penetrating keratoplasty with placement of ProKera at the Doheny Eye Institute. After surgery, patients received antibiotic and anti-inflammatory eye drops and were followed at 1 day, 1 week, 2 weeks, and then at 1 month intervals. Data collected included patient demographics, indications for surgery, transplant history, risk factors, and transplant results. The main outcome measures included corneal epithelialization, graft clarity, and signs of graft rejection.
Penetrating keratoplasty with placement of ProKera was performed on 35 eyes (13 right, 18 left, 2 patients both eyes). Indications for surgery included graft failure/graft rejection (30 eyes, including 1 Descemet’s membrane transplant), perforated corneal ulcers (2 eyes), corneal scar with extensive corneal neovascularization (2 eyes), and corneal decompensation secondary to phacomorphic glaucoma (1 eye). At PO month 1, complete corneal epithelialization was achieved in 26 grafts, and nonedematous graft clarity was seen in 24 eyes. In the 34 grafts followed to PO month 3, 5 additional grafts achieved complete epithelialization and graft clarity, and 5 previously healthy grafts developed corneal erosions, totaling 22 healthy grafts. Overall, 20 grafts encountered no complications after transplant, and 13 of these were followed beyond 6 months.
The sutureless application of amniotic membrane is an effective adjunct to penetrating keratoplasty in patients who may be at higher risk for delayed epithelialization and/or graft rejection. Its anti-inflammatory effects may be particularly beneficial for patients with a history of corneal perforations or multiple transplants.
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