Multilayer amniotic membrane combined with conjunctival flap for treatment of peripheral ulcerative keratitis

Abstract

Objective To observe the effect of multilayer amniotic membrane transplantation combined with conjunctival flap in the treatment of peripheral ulcerative keratitis in fresh perforation,so as to explore the clinical value of surgical methods. Methods A piece of preserved amniotic membrane tissue from Xi'an Eye bank before surgery was prepared.Twenty-one cases (21 eyes) of peripheral ulcerative keratitis with fresh perforation were collected in our hospital from 2008-2011,those dissolved in the surrounding with groove-like,corneal thickness of about 1/3-1/4 CT,the thinnest part was only the Descemet's membrane.All patients showed abnormal series of rheumatoid blood test before surgery,including rheumatoid factor (RF) was 3-5 times above the normal; in some patients anti-streptolysin O quantitative analysis (ASO) or super-sensitivity C-reactive protein were higher than normal; however,the value of anti-cyclic citrullinated peptide (ccp) antibody was normal.The cases were diagnosed as peripheral ulcerative keratitis.Medications were used to treat the corneal infections before the operation.The ulcerated necrotic tissue and peripheral immune complex deposition were removed,then the multilayer amniotic membrane was put on,with autologous pedicle conjunctival flap transposition in the amniotic membrane surface,intermittent fixed.Glucocorticoids drops and ointment were admitted locally,while systemic administration of immunosuppressive drugs was given according to medical consultation with autoimmune diseases. Results On 10-14 days postoperatively,18 patients with peripheral ulcerative keratitis nearly perforated area were become into a neovascularization,corneal wound healed after 1-2 months; only 3 patients recurred with the dissolution of limbal tissue after 1.5 months,which received the second same surgical procedure,corneal wound healed after 2 months.All the cases were followed up,only 1 patient developed a new peripheral ulcerative keratitis ulcer lesions near the surgical areal year after surgery.Conclusions Peripheral ulcerative keratitis is an eye disease associated with autoimmunity.In the lack of comeal donor material,multi-layer amniotic membrane combined with conjunctival flap is an effective method to treat peripheral ulcerative keratitis with fresh perforation. Key words: Amniotic membrane; Conjunctival flap; Peripheral ulcerative keratitis