Multilayer Amniotic Membrane Research Articles

A Comparison of the Efficacy of Autologous Serum Eye Drops with Amniotic Membrane Transplantation in Neurotrophic Keratitis

Purpose: To investigate and compare the efficacy of autologous serum eye drops with amniotic membrane transplantation in eyes with neurotrophic corneal ulcers. Methods: In this retrospective study, 42 eyes of 42 patients (30 females and 12 males) with neurotrophic corneal ulcers were included and divided into group I (n = 20) who were treated with autologous serum eye drops and group II (n = 22) who underwent amniotic membrane transplantation. The epithelial healing time and best corrected visual acuity were performed before and after treatments. Results: In group I, the mean age was 57.1 ± 10.1 years; and at the end of 6.7 ± 2.05 months follow up, 14 (70%) of 20 eyes healed completely with a minimal scarring and vascularization. Two patients had persistent epithelial defects, four patients healed incomplete because of deep stromal ulcers in eyes with post-herpes neurotrophic ulcers. In group II, the mean age was 58.7 ± 14.7 years. Seventeen eyes (72.7%) of 22 patients healed completely and there was no recurrence in these patients at the 6.8 ± 3.9 months follow-up period. Two incomplete healed patients had persistent epithelial defects caused by HSV and the other three patients had deep stromal ulcers caused by the abuse of topical anesthetics. The mean epithelialization time was 22.1 ± 8.0 days in group I and 20.0 ± 4.64 days in group II. In group I, best corrected visual acuity improved in 18 of 20 (90%) eyes and 17 of 22 (77.2%) eyes in group II. Conclusions: Both autologous serum eye drops and amniotic membrane transplantation are effective for eyes with neurotrophic corneal ulcers because of many epitheliotrophic factors. Also, we observed that multilayered amniotic membrane transplantation is more effective than autologous serum in deep corneal ulcers with postherpes neurotrophic keratitis in our cases.

Long-Term Follow-Up of Multilayer Amniotic Membrane Transplantation (MLAMT) for Non-Traumatic Corneal Perforations or Deep Ulcers with Descemetocele

To evaluate the long-term efficacy of multilayer amniotic membrane transplantation for reconstruction of epithelium and stroma in non-traumatic corneal perforations (less than 2 mm) or deep ulcers with descemetocele. Retrospective, non-comparative, interventional case series. Eleven consecutive patients with non-traumatic corneal perforations or deep corneal ulcers with descemetocele refractory to conventional treatments: herpetic or zoster keratitis (n = 4), Sjögren's syndrome (n = 2), rosacea (n = 1), hydrops (n = 1), mucous membrane pemphigoid (n = 1), bacterial keratitis (n = 1) and perforation after protontherapy for melanoma (n = 1). Intervention was: multilayer amniotic membrane transplantation with cryopreserved amniotic membrane. Complication rate and clinical outcome were evaluated in this long-term follow-up. Mean follow-up was 32 months (12 to 60). Integration of the multilayer amniotic membrane was obtained in 10 cases after one year. Corneal epithelium healed above the membrane in 10 cases within 3 weeks and remained stable after 32 months in 9 cases. Thickness of the stroma was increased and remained stable during the follow-up in 9 cases. In one case herpetic keratitis recurred with a corneal perforation. The clearing of the amniotic membrane was gradually obtained over a period of 11 months. Complications occurred in 15% of the eyes during the long-term follow-up. Multilayer amniotic membrane transplantation is a safe and efficient technique for a long restoration of the corneal integrity after non-traumatic corneal perforations or deep corneal ulcers with descemetocele. Long-term prognosis of these eyes depends of the gravity of the initial disease.

Tectonic DSAEK for the Management of Impending Corneal Perforation.

Purpose. To report a case of severe corneal thinning secondary to dry eye treated with a tectonic Descemet stripping automated lamellar keratoplasty (DSAEK) and amniotic membrane graft. Methods. A 72-year-old man with a history of long standing diabetes mellitus type 2 and dry eye presented with 80% corneal thinning and edema on the right eye and no signs of infectious disease, initially managed with topical unpreserved lubrication and 20% autologous serum drops. Eight weeks after, the defect advanced in size and depth until Descemetocele was formed. Thereafter, he underwent DSAEK for tectonic purposes. One month after the procedure, the posterior lamellar graft was well adhered but a 4 mm epithelial defect was still present. A multilayered amniotic membrane graft was then performed. Results. Ocular surface healed quickly and reepithelization occurred over a 2-week period. Eight months after, the ocular surface remained stable and structurally adequate. Conclusion. Tectonic DSAEK in conjunction with multilayered amniotic graft may not only provide structural support and avoid corneal perforation, but may also promote reepithelization and ocular surface healing and decrease concomitant inflammation.

Multilayer amniotic membrane transplantation for corneal penetrating injury

Objective To evaluate the effect of multilayer amniotic membrane transplantation for repairing the corneal tissue defect after corneal penetrating injury.Methods There were 7 cases (7 eyes) of corneal penetrating injury with corneal tissue defect or with infection of wound,which could not be sewed in regular methods.Multi-layer amniotic membrane transplantation were applied for them.They were followed up for an average of 14 months.Results 6 cases ( 85.71％ ) of corneal perforating resulted in wound healing,anterior chamber restoration,and stable anterior segment; One patient with severe infection in the eye,the amniotic membrane dissolved and the eyeball was enucleated.Conclusion For the smaller corneal penetrating injury patients with corneal tissae defect or wound infection,a multilayer anmiotic membrane transplantation is an effective and feasible surgical approach. Key words: Amniotic membrane; Transplantation; Injury, Corneal, penetrating

Surgical Management of Pediatric Limbal Dermoids With Sutureless Amniotic Membrane Transplantation and Augmentation

To further evaluate the efficacy of a new surgical technique for removal of pediatric corneal-limbal dermoids and ocular surface reconstruction using multilayered amniotic membrane. Three pediatric patients with corneal-limbal dermoid (grade I) in one practice were identified in a retrospective fashion. All patients underwent deep lamellar excision followed by sutureless multilayered amniotic membrane transplantation by a single surgeon (AP). Preoperative and postoperative visual acuity, anterior segment examination, anterior segment B-scan, and cycloplegic refraction were performed. Three patients with ages ranging from 6 months to 18 years had a postoperative follow-up of 9 to 12 months from the time of surgery. This surgical technique achieved rapid postoperative corneal re-epithelialization, reduced postoperative pain, and diminished postoperative scarring in all three patients. Existing preoperative astigmatism remained unchanged throughout the follow-up period. No intraoperative or postoperative complications were noted. This surgical approach offers an alternative surgical technique to a simple excision with or without deep lamellar keratoplasty for removal of pediatric corneal-limbal dermoids (grade I). In the management of pediatric limbal dermoids (grade I), surgical excision combined with sutureless multilayered amniotic membrane transplantation eliminates painful postoperative recovery and corneal neovascularization, and can achieve an improved long-term ocular surface cosmesis.

Aggressive Pterygium Growth and Corneal Scarring After Hyperopic Photorefractive Keratectomy

To describe a patient who noticed a corneal growth and accompanying rapid decrease in visual acuity soon after undergoing hyperopic photorefractive keratectomy (PRK). Interventional case report. A healthy 47-year-old white woman presented with a corneal growth after undergoing PRK. Visual acuity became progressively worse over 2 years. The growth transected the visual axis, measuring 180 μm centrally and 310 μm nasally. She underwent excisional biopsy, application of mitomycin C on the limbus and adjacent corneal tissue, and grafting with cryopreserved multilayer amniotic membrane. The pathologist reported findings consistent with pterygium. The patient initially experienced improvement in uncorrected visual acuity but then became noncompliant with topical steroids. The central anterior stroma became opacified to the extent of obscuring iris details. Best-corrected visual acuity at the last follow-up was 20/30. Because ultraviolet exposure is a risk factor for development and growth of pterygium, 1 possible explanation for this patient's findings is the effect of the excimer laser (which has a wavelength in the ultraviolet spectrum) on a previously insignificant corneal growth and/or the corneal limbal stem cells. Patients with corneal lesions suggestive of pterygia may be at increased risk for rapid lesion growth and aggressive corneal scarring after photorefractive keratectomy with a large ablation zone.

In Vivo Analysis of Stromal Integration of Multilayer Amniotic Membrane Transplantation in Corneal Ulcers

To evaluate integration of amniotic membrane into the corneal stroma using laser scanning in vivo confocal microscopy and anterior segment optical coherence tomography (AS-OCT). Prospective noncomparative interventional case series. Twenty-two eyes of 22 consecutive patients (mean age 53.9 ± 9.2 years) presenting with noninfectious corneal ulcers and stromal thinning unresponsive to medical treatment were enrolled. Multiple layers of amniotic membrane were applied over the ulcer bed to fill the ulcer crater and held in place with an overlying amniotic membrane patch, which was anchored to the surrounding cornea with 10-0 nylon interrupted sutures. Outcome measures were healing of the corneal ulcers, corneal morphology and stromal thickness changes at the ulcer site as measured by AS-OCT and surface epithelialization, stromal repopulation, and structural modifications of the amniotic membrane grafts as evaluated by confocal microscopy. Follow-up extended to 12 months. Successful result was observed in 20 of 22 eyes (90.9%). AS-OCT showed that the mean residual stromal thickness at the ulcer bed was 222 ± 70 μm before surgery. The mean thickness of amniotic membrane layers at the same site was 394 ± 80 μm while the mean total corneal thickness was 623 ± 51 μm at day 1 post surgery. Thereafter a progressive reduction in thickness to 420 ± 61 μm at 6 months occurred, after which the thickness stabilized. Confocal microscopy showed that integration of the amniotic membrane tissues with corneal stroma was preceded by epithelialization over the amniotic membrane covering the ulcer. This occurred 15 ± 5 days post surgery in the successful cases. Confocal microscopy also showed that the amniotic membrane patch was degraded during the first few weeks after surgery, while the integrated amniotic tissues underwent progressive modifications characterized by early loss of amniotic epithelial cells, changes in fibrillar structure, and migration into the amniotic stroma by corneal stroma-derived cells. Multiple layers of amniotic membrane can integrate into the corneal stroma with resulting increase in corneal thickness. This appears to be related to re-epithelialization of the transplanted membrane. Integrated amnion within the stromal defect undergoes progressive changes including contraction of tissue and repopulation by corneal stroma-derived cells.

Fibrin-glue assisted multilayered amniotic membrane transplantation in surgical management of pediatric corneal limbal dermoid: a novel approach

PurposeTo report a new surgical technique for excising pediatric corneal limbal dermoid and the post-resection ocular surface reconstruction.MethodsWe describe a method of deep lamellar excision followed by sutureless multilayered amniotic membrane transplantation in surgical management of corneal limbal dermoid.ResultThis technique achieves a rapid corneal re-epithelization, reduces post-operative pain, and will diminish post-operative scarring. Preoperative corneal astigmatism will persist.ConclusionThis method offers an alternative surgical approach in comparison to simple excision in removal of simple pediatric corneal limbal dermoids.

Anwendung mehrschichtig aufgenähter Amnionmembranen in der Erstbehandlung penetrierender Hornhautulzera

A corneal penetration secondary to inflammation or chronic trophic disease is an emergency situation in ophthalmology. The ocular globe is instable and there is a significant risk of an endophthalmitis. A corneal graft for a tectonic transplantation may not be available in many cases. The prognosis of an emergency corneal transplantation is relatively poor. We report the results of multilayer amniotic membrane transplantation as initial therapy for penetrating corneal ulcers. In 13 eyes with penetrating corneal ulcers an initial therapy with multilayer amniotic membrane was performed. All patients (11 men, 2 women; age 52-90 years; mean 71.7 years) were given therapeutic contact lenses as well as systemic and local antibiotics. We investigated the postoperative course with regard to stabilisation of the cornea and deepening of the anterior chamber. The anterior chamber was reestablished in 8 of 13 patients (62%) after an average of 5.25 days (range, 1-15) using multi-layer amniotic membrane transplantation. Our data show that an initial treatment of penetrating corneal ulcers with multilayer amniotic membrane is reasonable. With this procedure the surgeon gains sufficient time for obtain a corneal graft for a possible penetrating corneal transplantation.

Repair of oronasal fistulas with human amniotic membrane in minipigs

We evaluated the use of multilayer human amniotic membrane (HAM) as a grafting material for the repair of mid-palate oronasal fistulas in seven Berlin minipigs. After two weeks, three animals had the fistulas repaired with multilayered HAM grafts, three had them repaired with a collagen-based dermal substitute (INTEGRA ®, Integra Life Sciences, Plainsboro, NJ, USA), and one fistula was left untreated to serve as a control. Grafts were interposed between the oral and nasal mucosa, traversing the fistulas. After healing for 40 days, the pigs were killed for clinical, histological, and immunohistochemical examination. Two of the three fistulas closed with HAM were successful, the diameter of the third was reduced in size, and there was no change in the diameter of the fistula in the control. This study shows successful closure of oronasal fistulas in minipigs using interposed grafts of cryopreserved HAM, and offers promise as a simple and effective technique for tension-free closure of such fistulas.

A bioartificial surgical patch from multilayered human amniotic membrane—In vivo investigations in a rat model

The study was performed to evaluate the suitability of glycerol-cryopreserved human amniotic membrane (HAM) as a surgical patch, far from its common use in ophthalmic surgery. In vivo experiments in rat models were performed to study the degradation patterns, biocompatibility, postoperative tissue formation and its suitability for abdominal wall closure. Degradation and thickness of the membranes were assessed over a period of 60 days after subdermal implantation of monolayer and multilayer HAM in 96 immunocompetent and immunosuppressed rats. The tissue response was mild, and histological analysis evaluated that multilayer application and immunosuppression prolonged graft survival significantly. In a second rat model, another 18 animals were monitored over a period of 28 days after abdominal wall reconstruction with multilayered HAM. Polypropylene mesh (Prolene) and polyglactin910/polydioxanon patches (Ethisorb) served as controls. Gross examination and histological analysis proved that multilayer HAM was a sufficient material for abdominal wall closure in comparison with the polypropylene mesh and was superior to the polyglactin910/polydioxanon patch. Additionally, significantly reduced postoperative intraabdominal adhesions were observed when compared to the polyglactin910/polydioxanon patch. This study demonstrates that HAM is a biocompatible, resorbable surgical patch in a rat xenotransplantation model and serves as a mechanically sufficient material for abdominal wall closure in a small animal model. These findings are encouraging and justify further research for the use of cryopreserved human amniotic membrane in soft tissue repair.

Full thickness cornea transplantation to lamellar bad managing extensive corneal perforations

Abstract Purpose Present surgical techniques for managing extensive corneal perforations. Methods In three eyes of the three patients full thickness to lamellar bad cornea transplantations were performed because of the cornea perforations. In all cases previous to corneal grafting amniotic membrane was transplanted in tectonic purposes since donor corneas were not urgently available. Surgical techniques of the amniotic membrane transplantation consisted of intrastromal fluffed–up and intrastromal blanket‐fold multilayered amniotic membrane transplantations. Full thickness corneal grafts were decided because of the extensive descemet defects in the bad of the ulcers. Previously to the surgeries clinical diagnosis of ocular rosacea, herpetic keratitis and keratitis sicca were establisched in every consequent case. Additional sistemic treatment was administered for ocular rosacea and herpetic keratitis patients. Results In all three cases multilayered amniotic membrane transplantation showed sufficient effect for restoration integrity of the globe for short period. Full thickness corneal transplantation to lamellar bad was effective surgical procedure. In one case double anterior chamber was observed for 1 month. Conclusion 1.Multilayer amniotic membrane transplantation can be as the bridge to cornea grafting, in cases, when donor corneas are not urgently available. 2. For extensive corneal perforations full thickness cornea transplantation to lamellar bed is reliable method of treatment. 3. If corneal perforations are related to systemic disease it is necessary to administer appropriate regimen of the adjacent systemic medical treatment.

Recurrence of Peripheral Ulcerative Keratitis on the Corneoscleral Button in a Young Man Treated Successfully With Oral Corticosteroids

To describe recurrent peripheral ulcerative keratitis (PUK) on the corneoscleral graft in a young man treated successfully with oral corticosteroids. Interventional case report. A 21-year-old Malay man with no previous known medical illnesses presented with a sudden onset of peripheral corneal perforation. It was temporarily sealed with a multilayer amniotic membrane followed by patching with a corneoscleral button. One month later, a recurrence of PUK on the donor button was noted. It was successfully treated with oral corticosteroids. PUK without systemic manifestation may recur in the donor corneoscleral graft. Prompt intensive treatment with oral corticosteroids results in a favorable outcome.

Multilayer amniotic membrane transplantation for bacterial keratitis with corneal perforation after hyperopic photorefractive keratectomy: Case report and literature review

We report a case of corneal infection caused by Streptococcus pneumoniae after hyperopic photorefractive keratectomy (PRK) that produced severe corneal melting, ulceration, and multiple perforations. Treatment included antibiogram-based antibiotic topical therapy and multilayer amniotic membrane transplantation (AMT) performed to seal the perforations and restore the globe integrity. Clinical and anterior segment optical coherence tomography (Visante OCT, Carl Zeiss Meditec) examinations documented progressive integration of the amniotic membrane tissues within the cornea, stromal and epithelial healing, and recovery of a stable and regular anterior chamber. The cornea healed with an avascular leucoma; the best corrected visual acuity was reduced to 20/200. Severe pneumococcal ulcerative perforation is a potential complication of PRK. Penetrating keratoplasty, at high risk for failure in the acute settings of an infected and inflamed eye, can be delayed until the cornea is healed. Amniotic membrane transplantation may be an alternative surgical option to achieve this goal.

Amniotic Membrane Transplantation Combined with Antiviral and Steroid Therapy for Herpes Necrotizing Stromal Keratitis

To evaluate therapeutic effect of multilayer amniotic membrane transplantation (AMT) in conjunction with antiviral and corticosteroid therapy on herpes necrotizing stromal keratitis. Retrospective interventional case series. Fifteen patients (15 eyes) with herpes necrotizing stromal keratitis, persistent corneal inflammation, and impending ulcer, despite topical and systemic antiviral treatment for over 2 weeks. Multilayer AMT was performed in the 15 eyes. Antiviral medications and appropriate corticosteroids were administered after surgery. Remodeling of amniotic membrane (AM) and growth of epithelial cells were detected by confocal microscopy. Visual acuity and corneal status (ulceration, edema, and opacification). Follow-up ranged from 7 to 13 months (mean +/- standard deviation, 8.9+/-1.8). Visual acuity improved by > or =2 lines in 14 eyes. Central corneal ulcers healed completely at 2.0+/-0.6 weeks, and paracentral ulcers at 2.1+/-0.6 weeks (t = 0.314, P = 0.759). Corneal stromal thickness was restored in eyes with central ulcers at 2.4+/-1.2 weeks and in those with paracentral ulcers at 2.6+/-0.7 weeks (t = 0.425, P = 0.678). Superficial epithelial cells, together with small basal epithelial cells, gradually migrated to the surface of AM on postoperative weeks 1 to 3. There were corneal nebulae in 11 eyes, corneal maculae in 3 eyes, and a corneal leukoma in 1 eye at the end of follow-up. No recrudescence occurred in any eye. Multilayer AMT combined with antiviral and corticosteroid therapy appears effective in treating herpes necrotizing stromal keratitis. It provides patients with marked scars and visual impairment an opportunity for subsequent keratoplasty by arresting the inflammatory response and reducing the graft bed diameter.

Prise en charge chirurgicale des perforations cornéennes non traumatiques : étude rétrospective sur 8 ans

Treatment of nontraumatic corneal perforation is a difficult task. The aim of our study was to retrospectively analyze predisposing conditions leading to perforation, surgical treatments, and visual outcomes. Fifty-six patients were admitted in our department for a nontraumatic corneal perforation between 1997 and 2004. Mean patient age was 69 years (range, 16-95 years) and the mean follow-up was 20.5 months (range, 6-96 months). The diseases associated with perforations were neurotrophic ulcer in 24 cases (43%), peripheral immunologic ulcer in ten cases (18%), dry eye in six cases (11%), and infectious keratitis in seven cases (13%). All patients had specific adapted medical treatment before surgery. As a first procedure, we used cyanoacrylate glue in 14 cases (50% anatomic success), multilayer amniotic membrane transplantation in 23 cases (100% anatomic success), conjunctival flap in six cases, peripheral lamellar graft in three cases (33% anatomic success), emergency penetrating keratoplasty in 13 cases (31% anatomic success), and one patient's eye had to be eviscerated. Several surgical procedures were necessary in 16 cases (28%), nine patients needing total conjunctival flap at the end. We were able to achieve tectonic stability in 91% of eyes and 32% of patients recovered useful visual acuity between 20/400 and 20/50. Amniotic membrane transplantation is an effective method for managing corneal perforations and usually does not need a further reconstructive procedure. Visual outcome is poor when peripheral or central keratoplasty are needed. We recommend a conjunctival flap when descemetocele or perforation recurs despite previous surgical management.

Multilayer amniotic membrane transplantation for treatment of necrotizing herpes simplex stromal keratitis

To evaluate the efficacy of multilayer amniotic membrane transplantation (AMT) combined with antivirus and corticosteroid drug to treat necrotizing herpes simplex stromal keratitis. Thirteen patients (13 eyes) of necrotizing stromal keratitis were referred to Shandong Eye Institute and Qingdao Eye Hospital between January 2003 and April 2004. The course of disease was 3 - 22 months (mean 15 months). Corneal inflammation persisted and corneal ulcer progressed despite topical and systemic antiviral treatment for over 1 weeks. Multilayer amniotic membrane transplantation was performed after excluding of bacterial and fungal infection by microbiologic studies including smears and cultures of necrotic corneal tissue and confocal microscope. Topical and systemic antiviral medications were given with adjuvant corticosteroid eyedrops postoperatively. We investigated the healing of corneal ulcer and improvement of stromal edema with slit lamp biomicroscope, the integrity of corneal defect with fluorescein staining, the migration of healthy corneal epithelial cells and transformation of amniotic membrane with confocal microscopy. All patients were followed up for 3 - 13 months (mean 10 months). Corneal ulcer healed within 1 - 3 weeks postoperatively with negative fluorescein staining. Corneal stromal edema faded away within 1 month. Superficial amniotic membrane patches dissolved or shed on postoperative day 7 - 10, while the deeper grafts were adhered into the ulcer and fused with the surrounding fibroblasts. One of these grafts remained in situ more than 3 months. Confocal microscope examination indicated flat epithelial progenitor cells on the surface of residual amniotic membrane. Corneal transparence was achieved in 7 eyes, macula in 4 eyes and leucoma in 2 eyes 3 months after the operation. No recurrence of necrotizing stromal keratitis was occurred in 13 patients during the follow-up period. Multilayer AMT combined with antivirus and corticosteroid treatment is an effective method to treat necrotizing herpes simplex stromal keratitis.

Endophtalmie à staphylocoque après chirurgie de la cataracte chez un patient atteint de rosacée oculaire

To report staphylococcal endophthalmitis following cataract surgery in a patient with ocular rosacea. A 69-year-old man presented with decreased visual acuity in the right eye, a corneal abscess on the incision and hypopyon 2 weeks after phacoemulsification with intraocular lens placement. The patient was hospitalized. A diagnostic vitreous tap was performed. Antibiotic therapy was initiated both locally (two intravitreal shots + topical administration) and intravenously. Vitreal tap cultures indicated Staphylococcus aureus. The patient's clinical status improved 48 hours after the second intravitreal shot. The same bacterium was cultured from the patient's eyelids and incision abscess. Multilayer amniotic membrane transplantation enabled satisfactory healing of the corneal abscess, which had become perforative. The source of the S. aureus was the skin lesions on the patient's eyelids. Rosacea is a skin disease that frequently affects the face, nose and eyelids. Although good surgical techniques were performed, with the incision requiring suture, the risk of endophthalmitis after intraocular surgery was increased in the absence of proper preoperative treatment of the dermatological condition.

Multilayer amniotic membrane transplantation in the treatment of corneal perforations.

To determine if multilayer amniotic membrane transplantation (AMT) is useful in the treatment of corneal perforations, and in particular to assess to what extent efficacy is affected by perforation size. Fifteen patients (15 eyes) with corneal perforations of different sizes were divided into 3 groups: group A (microperforation, 6 eyes), group B (0.5-1.5 mm, 4 eyes), and group C (>1.5 mm, 5 eyes). The corneal perforation was caused by autoimmunity-related ulcer (3 eyes), neurotrophic ulcer (9 eyes), infectious keratitis (1 eye), or postkeratoplasty ulcer (2 eyes). Two layers of AM (for microperforations) or 3-4 layers (for the other groups) were trimmed to the size of the ulcer and sutured in place with interrupted 10-0 nylon sutures. In all cases, a bandage contact lens was then applied. Mean epithelialization time was 3.7 weeks (range 2-6). Mean time to recovery of corneal stroma thickness was 10.1 weeks (range 7-15). In all cases, ocular inflammation subsided within 2-5 weeks. The treatment was judged successful in 73% (11/15) of eyes. Three of the 4 unsuccessful treatments were of perforations 3 mm or more in diameter; of the 5 eyes with perforations of more than 1.5 mm in diameter, only 2 were treated successfully. These results suggest that multilayer AMT is effective for treating corneal perforations with diameter less than 1.5 mm. The technique may be a good alternative to penetrating keratoplasty, especially in acute cases in which graft rejection risk is high.

Treatment of corneal perforation with multilayer amniotic membrane transplantation

目的 观察羊膜移植治疗角膜溃疡穿孔的临床效果.方法对12例角膜溃疡穿孔行多层羊膜移植术.术后观察3～12月.结果12例中10例(83.33%)角膜穿孔瘢痕愈合;2例羊膜融解,穿孔未愈.结论多层羊膜移植治疗角膜溃疡穿孔是一种有价值的治疗方法。