Abstract
Abstract: :
Purpose: Patients with end–stage infectious corneal ulceration or melting corneal disorders frequently show an insufficient epithelial healing after emergency penetrating keratoplasty (PK). Beneficial properties of the amniotic membrane (AM) include promotion of epithelial healing, antiangiogenic, antiinfectious and immunomodulatory effects. The purpose of this study was to evaluate the impact of simultaneous amniotic membrane transplantation (AMT) on the short– and intermediate–term outcome of PK à chaud. Methods: PK à chaud (between 01/2001 and 10/2003) was performed with (group 1, n=20) or without (group 2, n=33) simultaneous AMT. Reasons for ulceration included: rheumatoid/areactive (6/17), herpetic (4/3), bacterial (4/4), neuroparalytic (1/0), necrotizing keratitis of unknown origin (1/5), limbal stem cell insufficiency (1/1), and melting of the graft after PK (3/3). The majority of these eyes (12/24) required immediate PK due to corneal perforation. In group 1 a 12–16 mm amnion patch was fixated episclerally by 10.0–nylon sutures and covered by a soft contact lens at the end of PK. The diameter of the corneal transplant varied from 3.5/3.0 mm to 8.2/9.5 mm and 7/15 were eccentric in groups 1/2. 25%/21% of patients received systemic immunosuppressive medication in addition to systemic steroids after PK. The mean follow–up time interval was 7.8/9.5 months in groups 1/2. Mean outcome measures included the postoperative rate of persistent epithelial defects and the necessity of subsequent surgical procedures. Results: In group 1 the AM was lost after 8.6 ± 3.3 days on average. At that time the epithelium was closed in 85% of the eyes. Eyes with AMT showed less persistent postoperative epithelial defects, in 90% of eyes with AMT vs. 61% of eyes without AMT the corneal epithelium was closed within 4 weeks (p= 0,02). 30%/46% developed suture loosening of the corneal transplant. 35%/36% of patients required 1–2/1–3 subsequent surgical procedures during the follow–up period including 3/6 AMT, 0/1 Re–PK and 1/1 conjunctival flap. Additionally, 10%/18% of patients had surgical correction of lid pathologies, and 15%/33% of eyes required autologous serum eye drops. At the end of follow–up 80%/70% of the corneal transplants were clear. Conclusion:Simultaneous AMT may be beneficial in eyes with severe corneal ulcerations or corneal melting disorders requiring immediate PK by reducing the incidence of persistent corneal epithelial defects and suture loosening.
Keywords: cornea: epithelium • cornea: clinical science • transplantation