Amniotic Membrane Transplantation-A Surgical Alternative in Peripheral Ulcerative Keratitis

Abstract

Introduction: Peripheral ulcerative keratitis (PUK) is a group of inflammatory corneal ulcers with stromal thinning and peripheral localization. It begins with immune cellular infiltrates in the juxtalimbal cornea, followed by a crescent-shaped ulcer that appears parallel to the limbus. Medical management includes intense lubrication, antibiotics, along with topical and systemic steroids and immunosuppressants. Definitive surgical management is lamellar patch or penetrating corneal graft. Amniotic membrane has wide array of biological properties, including anti-inflammatory, anti-bacterial, anti-angiogenic, antifibrotic, healing properties hence can be used as an alternative to keratoplasty. Material and Methods: This mono institutional observational retrospective study was conducted on 15 eyes of 15 patients having PUK in a tertiary health care centre. Patients underwent single-layered amniotic membrane transplantation (AMT) in case of corneal thinning involving <1/2 corneal stroma, multi-layered or rolled AMT in cases of corneal thinning involving >1/2 corneal stroma or with moderate to large perforations along with systemic steroids and immunosuppression. Results: All 15 Patients (100%) initially had symptomatic relief,2 patients (13.33%) underwent repeat AMT (86%success rate), 2 failures were noted, out of which 1 patient (6.67%) underwent corneal patch graft while 1 patient (6.67%) underwent large penetrating keratoplasty which failed and landed in Phthisis. Conclusion: AMT is a safe and effective alternative for the surgical management of PUK in combination with local and systemic immunosuppressive therapy. A close collaboration between the ophthalmologist and the physician is mandatory to prevent corneal perforation and decrease patient morbidity and risk of mortality