Abstract
BackgroundThe amniotic membrane (AM) is used in ocular surface reconstruction and is effective at promoting epithelialization and preventing corneal perforation in cases of acute microbial keratitis. Here, we report a case of isolated AM infection after AM transplantation for a persistent epithelial defect following tectonic penetrating keratoplasty. Case presentationA 47-year-old man with poorly controlled type 2 diabetes mellitus presented to the emergency department with a referral for perforated microbial keratitis. After ophthalmic examination, corneal scraping was performed, and corneal gluing was attempted and failed. Hence, the patient underwent tectonic penetrating keratoplasty. After keratoplasty, the patient developed a persistent epithelial defect that required AM transplantation as an overlay. Thirty days post-AM transplant, the patient presented with signs and symptoms resembling granular microbial infection of the cornea. After two days, the granular findings began dislodging from the corneal surface and were sent for culture, sensitivity, and histopathological identification. Histological analysis of the granular material indicated it to be a small piece of AM stroma infiltrated with mixed-type inflammatory cells. Corneal scraping cultures indicated Streptococcus mitis and Streptococcus oralis. ConclusionThe infiltrate was localized to the basement membrane of the AM as, despite the anti-inflammatory effects of AM, it can also act as a barrier against polymorphonuclear leukocyte infiltration from the tear film and microbial invasion into the cornea.
Highlights
The amniotic membrane (AM) can exert anti-inflammatory and antimicrobial effects, and contains antiangiogenic factors and protease inhibitors
The amniotic membrane acts as a physical barrier against the adhesive surface, potentially preventing infiltration of polymorphonuclear leukocytes from the tear film.[1,2]
We present an atypical case of microbial infection 30 days post-AM transplant that mimicked microbial keratitis and was confined to the amniotic membrane
Summary
The amniotic membrane (AM) can exert anti-inflammatory and antimicrobial effects, and contains antiangiogenic factors and protease inhibitors. It is effective at promoting epithelial healing and reducing inflammation, scarring, and angiogenesis. The amniotic membrane acts as a physical barrier against the adhesive surface, potentially preventing infiltration of polymorphonuclear leukocytes from the tear film.[1,2]. We present an atypical case of microbial infection 30 days post-AM transplant that mimicked microbial keratitis and was confined to the amniotic membrane. To the best of our knowledge, this is the first report of intra-amniotic infection after amniotic membrane transplantation (AMT)
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