Lyophilized amniotic membrane for corneal ulcer and post operative cross‐linking

Abstract

AbstractPatients with progressive keratoconus, especially in the early part of life, may benefit from crosslinking to accelerate the polymerization of corneal collagen, thus increasing the biomechanical strength of the cornea. The reference crosslinking protocol, recognized as the most effective in stabilizing the disease, corresponds to a classic crosslinking protocol with de‐epithelialization (epi off). This technique is pro‐inflammatory in patients who often have associated allergic keratoconjunctivitis. It is also painful postoperatively despite the systematic application of a dressing lens since it requires corneal de‐epithelialisation. The allergic background can lead to delays in healing with postoperative infections. Amniotic membranes have already been used in post refractive surgery. Their application in post‐crosslinking protocol epi off, directly on the patient's cornea without suture under a therapeutic contact lens, would reduce the intensity of pain after the procedure, complications such as infectious keratitis, sterile infiltrates, superficial or deep haze, aseptic corneal necrosis (thinning and fibrosis, perforation described), endothelial damage due to probable excessive free radical toxicity (reversible corneal decompensation or requiring a corneal graft), delayed epithelial healing (association of dry syndrome or blepharitis) and viral reactivation (Herpes Simplex virus or HSV). The amniotic membrane by its anti‐angiogenic, healing, anti‐inflammatory and anti‐infectious properties seems to have a decrease in post‐operative pain and an acceleration of corneal epithelial healing as in superficial corneal ulcers.