Amniotic membrane transplantation for infectious corneal ulcer treatment: a cohort retrospective study
Abstract
BACKGROUND Corneal ulcer is one of the most common causes of corneal blindness. This study aimed to describe the outcomes of amniotic membrane transplantation (AMT) in patients with infectious corneal ulcer.
METHODS A retrospective cohort study based on medical records of patients who underwent an adjuvant AMT procedure over a 2-year period (2015–2017) was conducted at Cipto Mangunkusumo Hospital Jakarta. Uncorrected visual acuity (UCVA) was measured with the Snellen chart. Treatment success was marked by complete healing (disappearance of corneal infiltrates, epithelial defect closure, and corneal scar formation). Healing time was the duration from AMT surgery to complete healing.
RESULTS 50 cases of infectious corneal ulcer, 12 of which had perforation were included. Gram-positive cocci (18%), gram-negative rods (14%), fungi (4%), and Acanthamoeba (2%) were isolated from culture specimens. Successful results were observed in 90% of cases (20/21 moderate cases and 25/29 severe cases). Healing time was 21 (14–63) days in moderate cases and 28 (14–90) days in severe cases. Baseline UCVA improved from 2.48 (0.22–2.80) logMAR to 1.30 (0–2.80) logMAR within 3–4 weeks postoperatively and to 0.94 (0–2.80) logMAR at the last follow-up. Post-AMT complications included recurrent perforation in 4 eyes, persistent epithelial defects in 2 eyes, amniotic membrane infection in 1 eye, and membrane retraction in 1 eye.
CONCLUSIONS AMT was successfully used to treat moderate and severe infectious corneal ulcer, particularly in nonresponsive and some perforated cases. AMT provides biochemical and mechanical support for corneal wound healing with good visual outcomes.
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References
Whitcher JP, Srinivasan M, Upadhyay MP. Corneal blindness: a global perspective. Bull World Health Organ. 2001;79(3):214-21.
Darsini IP. Demographic profile, clinical characteristics and therapy of keratitis and corneal ulcers in the Ophthalmology Clinic of Infection and Immunology Kirana Cipto Mangunkusumo Hospital period of January - December; 2013. Descriptive Study. Jakarta: Universitas Indonesia; 2015.
Hong AR, Shute TS, Huang AJW. Bacterial keratitis. In: Mannis MJ, Holland EJ. Cornea. 4th ed. Philadelphia: Elsevier; 2017. p. 875-901.
Guell JL, Gris O, Elies D, Manero F, Morral M. Indications for and uses of amniotic membrane. In: Mannis MJ, Holland, Edward J. Cornea. 4th ed. Philadelphia: Elsevier; 2017. p. 1581-7.
Rizzuti A, Goldenberg A, Lazzaro DR. Amniotic membrane allografts: development and clinical utility in ophthalmology. Chronic Wound Care Manag Res. 2014;1:67-72. https://doi.org/10.2147/CWCMR.S50955
Maholtra C, Jain AK. Human amniotic membrane transplantation: different modalities of its use in ophthalmology. World J Transplant. 2014;4(2):111-21. https://doi.org/10.5500/wjt.v4.i2.111
Paolin A, Cogliati E, Trojan D, Griffoni C, Grassetto A, Elbadawy HM, et al. Amniotic membranes in ophthalmology: long term data on transplantation outcomes. Cell Tissue Bank. 2016;17(1):51-8. https://doi.org/10.1007/s10561-015-9520-y
Solomon A, Meller D, Prabhasawat P, John T, Espana EM, Steuhl KP, et al. Amniotic membrane grafts for nontraumatic corneal perforations, descematoceles, and deep ulcers. Ophthalmology. 2002;109(4):694-703. https://doi.org/10.1016/S0161-6420(01)01032-6
Rodríguez-Ares MT, Touriño R, López-Valladares MJ, Gude F. Multilayer amniotic membrane transplantation in the treatment of corneal perforations. Cornea. 2004;23(4):577-83. https://doi.org/10.1097/01.ico.0000121709.58571.12
Abdulhalim BH, Wagih MM, Gad AA, Boghdadi G, Nagy RR. Amniotic membrane graft to conjunctival flap in treatment of non-viral resistant infectious keratitis: a randomised clinical study. Br J Ophthalmol. 2015;99(1):59-63. https://doi.org/10.1136/bjophthalmol-2014-305224
Chen HC, Tan HY, Hsiao CH, Huang SC, Lin KK, Ma DH. Amniotic membrane transplantation for persistent corneal ulcers and perforations in acute fungal keratitis. Cornea. 2006;25(5):564-72. https://doi.org/10.1097/01.ico.0000227885.19124.6f
Fan J, Wang M, Zhong F. Improvement of amniotic membrane method for the treatment of corneal perforation. Biomed Res Int. 2016;2016:1693815. https://doi.org/10.1155/2016/1693815
Tabatabaei SA, Soleimani M, Behrouz MJ, Torkashvand A, Anvari P, Yaseri M. A randomized clinical trial to evaluate the usefulness of amniotic membrane transplantation in bacterial keratitis healing. Ocul Surf. 2017;15(2):218-26. https://doi.org/10.1016/j.jtos.2017.01.004
Gicquel JJ, Bejjani RA, Ellies P, Mercié M, Dighiero P. Amniotic membrane transplantation in severe bacterial keratitis. Cornea. 2007;26(1):27-33. https://doi.org/10.1097/ICO.0b013e31802b28df
Altay Y, Tamer S, Burcu A, Balta Ö. Amniotic membrane transplantation in bacterial and herpetic stromal keratitis. Turk J Med Sci. 2016;46:457-62. https://doi.org/10.3906/sag-1501-6
Hapsari D, Gondhowiarjo TD, Susiyanti M. Effectiveness and safety of combined therapy of superficial keratectomy with amniotic membrane transplantation and topical autologous plasma in bacterial corneal ulcer [thesis]. [Jakarta]: Universitas Indonesia; 2014.
Thatte S, Choudhary U, Sharma B. Efficacy of amniotic membrane transplantation in refractory infective keratitis leading to stromal thinning, descematocele and perforations. JOJ Ophthal. 2017;3(3):555611. https://doi.org/10.19080/JOJO.2017.03.555611
Kheirkhah A, Tabatabaei A, Zavareh MK, Khodabandeh A, Mohammadpour M, Raju VK. A controlled study of amniotic membrane transplantation for acute Pseudomonas keratitis. Can J Ophthalmol. 2012;47(3):305-11. https://doi.org/10.1016/j.jcjo.2012.03.014
Ljubimov A, Saghizadeh M. Progress in corneal wound healing. Prog Retin Eye Res. 2015;49:17-45. https://doi.org/10.1016/j.preteyeres.2015.07.002
Kang BS, Kim MK, Wee WR, Oh JY. Infectious keratitis in limbal stem cell deficiency: Stevens-Johnson syndrome versus chemical burn. Cornea. 2016;35(1):51-5. https://doi.org/10.1097/ICO.0000000000000677
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