Abstract
In our retrospective study we evaluated the efficacy of an improved amniotic membrane (AM) roll-in filling technique (AMR) combined with multilayer amniotic membrane cover to treat corneal perforation and included 46 cornea perforations ≤ 3 mm in diameter treated with AMR and 20% C3F8 mixed gas filling of the anterior chamber. Anterior chamber depth, aqueous leakage, bubble maintenance time, and cornea morphology were monitored after each operation. The mean diameter of corneal perforation was 1.60 ± 0.55 mm (range 0.5–3) and the success rate of the AMR method for corneal perforation reconstruction was 100% after a single operation. Anterior chamber depth was normally reconstructed without AMR break-off, aqueous leak, or other complications. The mean time of the C3F8 gas bubble in the anterior chamber was 8.6 ± 2.0 days (range 4–12). At the last follow-up, all patients' visual acuity was improved to varying degrees. The mean follow-up time was 11.0 ± 5.6 months (range 3–36). The AMR plugging combined with multilayer AM cover is a secure and easy intervention, which led to 100% success in our study. Various perforations ranging from trauma to infection can be treated with AMR, which is especially practical in those countries where donor cornea availability is limited.
Highlights
Corneal perforation is one of the most serious complications of infections and autoimmune diseases as well as traumata
The anterior chamber center depth of all patients recovered to 5 times the corneal thickness, which is above 2.5 mm
The optical coherence tomography (OCT) image showed that the amniotic membrane (AM) was fully epithelialized, the perforation was healed completely with an increase in the stromal thickness, and there was a loose layer between the AM and the corneal stroma, indicating that the AM was not substituted by corneal collagen tissues at this time (Figure 2(d))
Summary
Corneal perforation is one of the most serious complications of infections and autoimmune diseases as well as traumata. Amniotic membrane transplantation (AMT) for the treatment of corneal ulcers was first introduced by Lee and Tseng [3] in 1997. Thereafter, it has been widely used for various ocular surface reconstructions. AMT could promote ocular surface tissue healing of persistent epithelial defects (PEDs), corneal ulcers, and eye burns [7,8,9,10]. Clinical results showed that the success rate of treatment for corneal ulcers with single or multilayer AMs was over 80% [10, 11], while for cornea perforation with multilayer AMT it was about 73% [12]. Based on the usage of AM for healing of cornea tissues and the few reported cases of AMR interventions for cornea perforation treatment, we performed modified AMR interventions combined with multilayer amniotic membrane cover for a variety of corneal perforations up to 3 mm in diameter
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