Lamellar Keratoplasty Combined with Amniotic Membrane Transplantation for the Treatment of Corneal Perforations: A Clinical and In Vivo Confocal Microscopy Study.

Lan Ke,Dan Shen,Chen Qiao,Qingyan Zeng,Haoyu Wang

doi:10.1155/2020/7403842

Lan Ke, Dan Shen + Show 3 more

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https://doi.org/10.1155/2020/7403842

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Abstract

Purpose To evaluate the clinical and in vivo confocal microscopy outcome of lamellar keratoplasty combined with amniotic membrane transplantation for the treatment of corneal perforations. Methods In this retrospective, noncomparative, and interventional case series, 13 eyes of 13 patients with corneal perforation were included. All eyes were treated with lamellar keratoplasty combined with amniotic membrane transplantation for corneal reconstruction. Age, underlying etiology, location, size of corneal ulcer, size of corneal perforation, hospitalization days and follow-up time, and corneal confocal microscopy were investigated. Aqueous leakage, anterior chamber formation, epithelial healing time, and visual acuity (VA) were monitored after operation. Results The cause of corneal perforation (n = 13) was classified as infectious (n = 13) was classified as infectious (n = 13) was classified as infectious (Conclusion Lamellar keratoplasty combined with amniotic membrane transplantation may be an alternative, safe, and effective surgical therapy in the treatment of corneal perforations in the absence of a fresh donor cornea. We recommend this surgery to treat with the size of corneal perforation of <4 mm in diameter no matter peripheral or central corneal perforation, especially who had immune-related diseases.

Highlights

Corneal perforation is one of the blinding diseases caused by various infectious and noninfectious corneal diseases
All patients received an anatomical cure after surgery. e anterior chambers were formed without aqueous leakage and other complications at postoperative day
One of the patients needed to be discharged from the hospital for systemic radiation therapy, so we were not sure when her corneal epithelium was repaired (Case 6). e mean time of regained a smooth corneal surface was 7.5 ± 2.9 days. e mean hospitalization day was 13.1 ± 4.5 days. e mean followup time is 22.5 ± 14.5 months. e amniotic membranes (AMs) layers had integrated into the stroma at the perforation ulcer site from the slit-lamp and confocal microscopy (Figure 2)

Summary

Introduction

Corneal perforation is one of the blinding diseases caused by various infectious and noninfectious corneal diseases. Corneal perforation has a low prevalence in developed countries, it remains one of the major diseases in developing countries that require emergency surgery [2, 3]. In order to maintain the anatomical integrity of the cornea and prevent complications from happening, immediate treatment is required. For the treatment of corneal perforation, we often use surgical and/ or nonsurgical methods to intervene. Interventions include wearing soft contact lenses, using tissue biogels [4], simple suturing, conjunctival flap covering surgery, multilayer amniotic membrane transplantation [5, 6], and keratoplasty [7,8,9,10]

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Conclusion