Abstract
Purpose To report on surgical approaches using amniotic membrane applications and patch grafts in corneal melting and perforations. Anatomical and functional results, including advantages and disadvantages of the interventions, will also be explored. Methods A five-year retrospective analysis of 189 surgical treatments involving corneal melting with perforation was performed. In one evaluated treatment type, a graft of amniotic membrane, often folded one to three times, was sutured with the epithelial side facing the previously mechanically debrided corneal tissue. A larger monolayer amniotic patch was then sutured, with the epithelial side facing the top of the first membrane, to the perilimbal conjunctiva. For corneal patch grafts, the size-fitting technique of graft trephination was applied, and the donor-recipient junctions were sewn with interrupted sutures. All the procedures were evaluated, noting outcomes and complications of surgery, preoperative and postoperative visual acuities, postoperative intraocular pressures, graft rejection, and other late comorbidities and complications. Results We performed 119 amniotic membrane applications (63%) and 70 corneal patch grafts (37%). Anatomical reconstruction of the anterior chamber was achieved in 157 eyes, of which 102 eyes (86%) received an amniotic membrane and 55 eyes (79%) were treated with the patch graft technique. In 63 eyes (33%), more than one amnion or graft treatment was necessary to close the corneal perforation. Conclusions The success of medical and surgical management depends on the cause of corneal melting, and amniotic membrane applications often require further intervention; nevertheless, patch grafts deliver better tectonic reconstruction than amniotic membrane alone.
Highlights
Serious progressive corneal stromal dissolution may lead to corneal ulceration and, subsequently, corneal perforation
Corneal perforation is always a medical emergency requiring rapid medical intervention. ere are several known predisposing factors leading to serious stromal dissolution and disintegrity of the globe. ese include infection, Sjogren syndrome, systemic disease, sterile inflammation, Stevens–Johnson syndrome, tear-film abnormality, prior ocular surgery, collagen vascular disease, neurotrophic keratopathy, persistent epithelial defect, chemical or thermal injury of the ocular surface, and use of topical medications that contain preservatives [1,2,3,4,5,6,7,8,9]
Metalloproteinases play a fundamental role in the inflammatory response. eir proteolytic activity can regulate proand anti-inflammatory cascades and are regulative in the processes of tissue remodelling. e matrix metalloproteinase (MMP) are shown to have a role in infectious and noninfectious causes of corneal tissue destruction [9,10,11]. e management and timing of corneal melting, ulceration, and consecutive perforation depends on the cause, size, corneal infiltration, location of perforation, and status of other ocular tissues [12, 13]
Summary
Katarzyna Krysik ,1 Dariusz Dobrowolski ,2,3 Edward Wylegala, and Anita Lyssek-Boron 1. To report on surgical approaches using amniotic membrane applications and patch grafts in corneal melting and perforations. A five-year retrospective analysis of 189 surgical treatments involving corneal melting with perforation was performed. In one evaluated treatment type, a graft of amniotic membrane, often folded one to three times, was sutured with the epithelial side facing the previously mechanically debrided corneal tissue. We performed 119 amniotic membrane applications (63%) and 70 corneal patch grafts (37%). Anatomical reconstruction of the anterior chamber was achieved in 157 eyes, of which 102 eyes (86%) received an amniotic membrane and 55 eyes (79%) were treated with the patch graft technique. E success of medical and surgical management depends on the cause of corneal melting, and amniotic membrane applications often require further intervention; patch grafts deliver better tectonic reconstruction than amniotic membrane alone Conclusions. e success of medical and surgical management depends on the cause of corneal melting, and amniotic membrane applications often require further intervention; patch grafts deliver better tectonic reconstruction than amniotic membrane alone
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
