Serial Multilayer Amniotic Membrane Transplants for Graft-Versus-Host Disease-Associated Bilateral Corneal Perforations: Case Report

Abstract

Purpose: To report a case of bilateral corneal perforations associated with graft-versus-host disease (GVHD) that was successfully treated with serial multilayer amniotic membrane (AM) transplants (AMT) and systemic immunosuppressants. Methods: Interventional case report. Results: A 50-year-old Chinese male with leukemia was referred for evaluation of dry eyes and corneal ulcers, manifested by intractable central corneal melting bilaterally, secondary to chronic GVHD after bone marrow transplantation. He failed treatment with a preservative-free lubricant, soft contact lens bandages, topical and systemic steroids, and bilateral permanent punctal occlusion. Bilateral corneal perforations resulted and he was treated urgently with multi-layer AM grafting at the perforation site (inlay) and the entire cornea (overlay), 2 times for the right eye and 3 times for the left eye, combined with systemic immunosuppressants. Over a follow-up period of 12 months, stability of the corneal epithelium and stroma was verified. Conclusions: A single AMT did not arrest the corneal melt and rescue his corneas. Immunosuppressants played a role in the success of treatment. Serial multilayer AMT should be combined with systemic immunosuppressants to treat corneal perforations and reconstructing the ocular surface in cases of severe ocular GVHD.