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 Table of Contents    
LETTER TO THE EDITOR
Year : 2019  |  Volume : 12  |  Issue : 1  |  Page : 68-69  

Management of recalcitrant corneal ulcers with dry processed amniotic membrane


1 Department of Ophthalmology, Rustaq Hospital, Rustaq, Oman
2 Kasturba Medical College, Manipal, Karnataka, India

Date of Web Publication30-Jan-2019

Correspondence Address:
Dr. Jagdish Bhatia
Department of Ophthalmology, Rustaq Hospital, PO Box 421, PC 329, Rustaq
Oman
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ojo.OJO_95_2018

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How to cite this article:
Bhatia J, Narayanadas B, Varghese M, Mansi MA, Mohamed MF, Hafez Gad AA, Bhatia N. Management of recalcitrant corneal ulcers with dry processed amniotic membrane. Oman J Ophthalmol 2019;12:68-9

How to cite this URL:
Bhatia J, Narayanadas B, Varghese M, Mansi MA, Mohamed MF, Hafez Gad AA, Bhatia N. Management of recalcitrant corneal ulcers with dry processed amniotic membrane. Oman J Ophthalmol [serial online] 2019 [cited 2019 Aug 24];12:68-9. Available from: http://www.ojoonline.org/text.asp?2019/12/1/68/251044



Sir,

Management of recalcitrant corneal ulcer of any etiology is always challenging to ophthalmologists. The mainstream of current medical practice of resistant corneal ulcer includes intensive topical fortified antibiotics with supportive therapy. When these medical therapies fail, one may consider autologous serum, conjunctival flap, tarsorrhaphy, or penetrating keratoplasty. In the recent past, amniotic membrane transplantation (AMT) has been successfully used to treat persistent corneal epithelial defects and ulcers of diverse etiologies.

AMT for the treatment of corneal ulcers was first introduced by Lee and Tseng[1] in 1997. The unique property of amniotic membranes (AMs) in the reconstruction of ocular surfaces is that it contains amazing mixture of growth factors and cytokines, facilitating proliferation and differentiation of epithelial cells, reducing the inflammatory response by inhibiting protease activity, and reducing inflammatory cell activity.[2],[3] Clinical results showed that the success rate of treatment for corneal ulcers with AMT is over 80%.[4],[5]

In our prospective study, we evaluated the benefit of use of commercially available dried and processed AM in the management of resistant corneal ulcers. Sutureless AMT is valuable in the office setting to promote healing of recalcitrant corneal ulcers that are not responding well to conservative treatment. Topical medications can be used simultaneously as medication penetration has not been found to be an issue. All the patients tolerated AM very well.

Between July 2016 and May 2018, eight eyes (5 men and 3 women with a mean age of 67 years), who suffered from recalcitrant corneal ulcers after failure of conventional ulcer treatment for >7 days were treated with commercially available dried and processed amniotic membrane. Inclusion criterion for our modified treatment was the size of ulcer >5 mm in diameter with or without hypopyon. Cases with viral keratitis were not included in the study. Out of eight cases, four cases were of bacterial etiology [Figure 1] while other four did not show any conclusive growth on culture.
Figure 1: Patient with large corneal ulcer before amniotic membrane transplantation

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   How to Apply Amniotic Membrane in the Office Top


Under topical anesthesia, the base of the ulcer was debrided with 23-gauge needle. AM grafts were overlaid in small pieces over the debrided area. The whole corneal ulcer surface was covered by the AM pieces, followed by bandage contact lens as cover. The membrane was placed with stromal side down (Orient the graft with the “IOP” watermark facing the physician to ensure that the stromal side is in contact with the eye) [Figure 2]. Documentary photographs were taken.
Figure 2: Identifying the stromal side of amniotic membrane (IOP mark should face up)

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After AM transplantation, seven eyes achieved rapid epithelialization within 2–3 weeks (range 14–28 days) [Figure 3] except one case who had postcataract surgery epithelial defect and took 6 weeks to epithelize.
Figure 3: Two weeks after amniotic membrane transplantation

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   Conclusion Top


In-office sutureless AMT is easy to use and safe procedure and could become a part of treatment algorithms in the disease course to improve patient outcomes. It is conclusively evident that AMT has certainly gained an acceptable position in the armamentarium of the ophthalmologists in the management of recalcitrant corneal ulcers.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Lee SH, Tseng SC. Amniotic membrane transplantation for persistent epithelial defects with ulceration. Am J Ophthalmol 1997;123:303-12.  Back to cited text no. 1
    
2.
Na BK, Hwang JH, Kim JC, Shin EJ, Kim JS, Jeong JM, et al. Analysis of human amniotic membrane components as proteinase inhibitors for development of therapeutic agent for recalcitrant keratitis. Placenta 1999;20:453-66.  Back to cited text no. 2
    
3.
Sato H, Shimazaki J, Shinozaki K. Role of growth factors for ocular surface reconstruction after amniotic membrane transplantation. Investig Ophthalmol Vis Sci 1998;39:S428.  Back to cited text no. 3
    
4.
Prabhasawat P, Tesavibul N, Komolsuradej W. Single and multilayer amniotic membrane transplantation for persistent corneal epithelial defect with and without stromal thinning and perforation. Br J Ophthalmol 2001;85:1455-63.  Back to cited text no. 4
    
5.
Solomon A, Meller D, Prabhasawat P, John T, Espana EM, Steuhl KP, et al. Amniotic membrane grafts for nontraumatic corneal perforations, descemetoceles, and deep ulcers. Ophthalmology 2002;109:694-703.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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