Cryopreserved Amniotic Membrane, Autologous Serum Eye Drops, and Tea-Tree Oil Lid Scrubs in combination for the treatment of Keratoconjunctivitis in a Staphylococcus Hypersensitive Teenager

Abstract

Abstract
 Background and Objective: The purpose is to present an interventional case report detailing recurrent bilateral keratoconjunctivitis secondary to Staphylococcus hypersensitivity in a teenage female. At least three times yearly, for five years, the patient has experienced episodes of severe bilateral catarrhal infiltrative or phlyctenular keratoconjunctivitis. Comprehensive corneal and conjunctival cultures had been historically performed, twice, yielding only growth of Staphylococcus aureus and epidermidis. Prior short-term treatment regimens of topical steroids and antibiotics had not prevented recurrences.
 Methods: This is an interventional case report: In this patient, placement of a topical cryopreserved amniotic membrane, Prokera Slim (PKS by BioTissue), after one week of topical steroid treatment (Durezol (difluroprednate 0.05%) qid) in the right eye (OD) is compared to a steroid (difluroprednate 0.05%) taper in the left eye (OS) over an approximate one-month time period. Both eyes then continue chronic, long-term maintenance therapy with autologous serum eye drops (ASED) dosed six times daily and tea tree oil containing lids scrubs (SteriLid Foam by TheraTears) two times daily, until the present time. Supportive meibomian gland expression for meibomian gland dysfunction was also performed at the three month treatment mark.
 Results: The PKS treatment in the right eye resulted in superior visual acuity and ocular comfort when compared to a steroid taper in the left eye over an approximate one-month time period. These results were maintained in the left eye at the 12 month- time frame. The right eye experienced a recurrence when the patient self-discontinued all therapy in both eyes at the 4 month mark. With re-initiation of maintenance therapy of ASED and tea tree oil containing lids scrubs, she has remained symptom-free for over eight months in the right eye. 
 Conclusions: Further comparison and study of the treatment modalities above could result in a potentially faster, safer, and superior treatment and prevention protocol for topical ocular inflammation in Staphylococcus hypersensitive keratoconjunctivitis, particularly in pediatric populations.