Ocular surface rehabilitation: Application of human amniotic membrane in high-risk penetrating keratoplasties

Abstract

BackgroundHuman amniotic membrane is a versatile tool for management of ocular surface disorders. This study evaluates the effect of cryopreserved human amniotic membrane (hAM) on one-year survival of penetrating keratoplasties (PKP) in high-risk recipients. MethodThis is a retrospective noncomparative cohort study of 58 consecutive eyes undergoing PKP with concurrent placement of a self-retained cryopreserved hAM (PROKERA®) at a tertiary care center from January 2009 to July 2010. ResultsMean patient age was 66.7±17.2years and 30 (54%) were males. 51 eyes were pseudophakic and one aphakic. 27 eyes were glaucomatous; 24 had glaucoma drainage device and 2 had previous endocyclophotocoagulation. 12 patients had PKP for the first time and 46 had repeat PKP (average number of prior PKP=1.63±1.1, range: 1–5).Risk factors for graft failure included repeat PKP (79.3%), corneal neovascularization (51.7%), preexisting glaucoma (46.6%), and presence of anterior synechiae (37.9%). Both First Transplant and Repeat Transplant groups had similar survival rates until 6months after transplant (75% vs 74%, odds ratio=1.06, p=1.00). At 12months, First Transplant group showed a better survival rate (67% vs 43%, odds ratio=2.60, p=0.20). Eyes with >3 risk factors had a higher graft failure rate (odds ratio=5.81, p=0.003). ConclusionSurvey of the literature suggests that high-risk PKP with concurrent hAM placement demonstrate comparable graft survival. Presence of multiple risk factors is associated with poor survival.