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L. Liang, H. Sheha, Z. Liu; Amniotic Membrane Extract for Neurotrophic Keratopathy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2391.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the effect of topical amniotic membrane extract (AME) for treatment of neurotrophic keratopathy in a pilot study.
Fourteen consecutive patients (14 eyes) with persistent neurotrophic keratopathy were treated by administration of eye-drops containing 100 µg/ml AME. The neurotrophic keratopathy developed following herpes keratitis (6 eyes), diabetes mellitus (5 eyes), post-keratoplasty (4 eyes), post-neurosurgery (4 eyes), ocular surface medicamentosa (3 eyes), and radiation for nasopharyngeal cancer (1 eye). The epithelial healing was monitored by slit lamp exam; corneal sensitivity was checked using Charcot-Bonnet aesthiometer; visual acuity, Schirmer test, and tear breakup time (BUT) were also recorded.
Healing started 6.7±2.4 days after initiation of AME treatment. All but two eyes achieved complete epithelialization in 22±13.5 days. Among the 12 eyes where complete healing were achieved, partial improvement in corneal sensitivity occurred in 9 eyes (75%) while no change occurred in 3 eyes (25%). The mean corneal sensitivity improved from 16.7±8.3 mm at baseline to 19.2±7.9 mm at the time of AME cessation (66±13.5 days) (p=0.01), and 23.8±11.1 mm at 6 months follow-up (p=0.01). Visual acuity improved in 8 eyes (66.7%), no change in 2 eyes (16.7%), and got worst in 2 eye (16.7%). Schirmer test and BUT increased from 4.5±1.6 mm/5min and 0 sec at base line to 5.3±1.3 mm/5min and 1.9±0.8 sec at the time of AME discontinuation (p=0.07, 0.02), 5.6±1.4 mm/5min and 2±0.6 sec at 6 months visit (p=0.01, 0.02). Ulcer recurrence was seen in 2 eyes but both healed again 10 days and 18 days respectively after a second round therapy. No ocular or systemic side effects were found during a follow up period of 8.1±2.2 months.
The results of this preliminary pilot study suggest that AME is an effective alternative treatment for neurotrophic keratopathy. Further studies are needed to clarify the underlying mechanism.
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