Combined anterior chamber washout, amniotic membrane transplantation, and topical use of corticosteroids for severe peripheral ulcerative keratitis.

Abstract

The aim of this study was to evaluate the efficacy of anterior chamber washout, amniotic membrane transplantation, and topical use of corticosteroids in the treatment of severe peripheral ulcerative keratitis with membranous endothelial exudation. Twelve patients (12 eyes) with severe corneal ulceration were included. All ulcers were located at the corneal periphery, accompanied by central corneal epithelial defects and stromal edema. Membranous endothelial exudates were observed by anterior segment optical coherence tomography. The duration of the ulcers was 1 to 10 months (mean, 3.0 ± 2.9 months) before the patients visited our institution. Corneal inflammation and ulceration could not be controlled after 2 weeks of topical antiinflammation treatment. Bacterial, fungal, and Acanthamoeba infections were not detected. Surgical treatment was performed. After the necrotic corneal tissue was cut, exudation clinging to the endothelium was removed. Then, amniotic membrane was placed on the corneal lesion. Postoperatively, corticosteroid eye drops and topical and systemic antiinflammation medication were given. Healing of corneal ulcers and improvement of stromal edema were detected by slit-lamp microscopy. All patients were followed up for 3 to 15 months (mean, 6.5 ± 3.7 months). All corneal ulcers healed by 1 to 2 weeks after surgery. The corneal stromal edema subsided within 1 month. All patients achieved a stable ocular surface. There was no recurrence during the follow-up. Anterior chamber washout and amniotic membrane transplantation combined with topical corticosteroids seems to be effective for the treatment of severe peripheral ulcerative keratitis with endothelial exudates.