Abstract
Purpose :
To evaluate the effectiveness of office based amniotic membrane grafts (AMG) in treating persistent epithelial defects (PED), and to determine if tarsorrhaphy assists in resolution of AMG treatment failures.
Methods :
A retrospective chart review was performed on consecutive patients treated with AMG from March 2014 to October 2016. Information reviewed included: patient age and gender, indication for AMG, previous therapies, duration of the AMG, time to documented epithelial closure with AMG, and treatment failure. In patients with PED and AMG failure who went on to receive a tarsorrhaphy, the time to epithelial closure was recorded.
Results :
Sixty eyes received AMG in the study period. Of those, 29 (mean age:74, range 27-95, 55% female), were identified as having a PED due to: HSV (35% [10/29]), HZV (10% [3/29]), neurotrophic ulcers (17% [5/29]), and PED unspecified (38% [11/29]). Eyes treated for indications other than PED were excluded. All 29 patients had prior treatment with lubricating eye drops and antibiotics. Eleven out of 29 patients had prior placement of a bandage contact lens and 1 patient had received a conjunctival flap. Patients that healed with AMG alone averaged 19.2 days (range: 2-27 days) from AMG placement to resolution. Ten out of 29 patients (34.5%) diagnosed with PED failed treatment with AMG and underwent tarsorrhaphy. The average time to tarsorrhaphy in the AMG failure group was 16.9 days (range: 3-36 days) from the placement of the AMG. The average time to heal with tarsorrhaphy was 30.1 days (range: 11-47 days).
Conclusions :
AMG is commonly attempted before tarsorrhaphy due its ease of placement and non-invasive nature. However, AMG is insufficient in certain cases due to severe disease, slow healing, and the temporary nature of a dissolvable AMG. One third of patients in our study who were treated for PED with AMG were deemed failures, and went on to receive tarsorrhaphy. All patients who underwent tarsorrhaphy healed without further intervention. While tarsorrhaphy is more invasive than AMG, it is an inexpensive and effective treatment option for PED. Tarsorrhaphy should be considered as a viable treatment option for PED, especially after failure with non-invasive modalities.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.