Multilayer Amniotic Membrane Transplantation Research Articles

Multilayered-Amniotic Membrane Transplantation in Gunshot Powder Injury: A Case Report

Background: Amniotic membrane transplantation has been widely used to repair various ocular surface conditions, including inflammatory, infectious, traumatic, and neoplastic conditions, with satisfactory results. a case of a 34-year-old male hit by a gunpowder explosion.
 Case presentation: We reported a case of a 34-year-old male hit by a gunpowder explosion. The right eye was hyperemic and felt blurry after the incident. On examination of the right eye, visual acuity was 20/150, and foreign bodies and erosion were found in the cornea. The patient planned to do foreign body extraction followed by a multilayered-amniotic membrane transplantation (ML-AMT) procedure. On the first and second day of follow-up, on the right eye, the visual acuity was 1/300, palpebral edema was decreased, and subconjunctival hemorrhage was found. On the cornea, there were ML-AMT and bandage contact lenses.
 Conclusion: Gunshot powder injury in the eyes is quite rare. The damage that can occur ranges from corneal epithelium abrasion to perforation and rupture of the eyeball. AMT has been successfully used in the management of eye trauma with defects on the ocular surface.

Amniotic membrane transplantation combined with conjunctival flap covering surgery for the treatment of corneal perforations in fungal keratitis

PurposeTo investigate the efficiency of amniotic membrane transplantation (AMT) combined with conjunctival flap covering surgery (CFCS) for patients with corneal perforations in fungal keratitis (FK). MethodsIn this non-comparative, retrospective case series, 16 participants of corneal perforation in FK were successfully treated by a combination of multilayer AMT and bipedicle conjunctival flap with partial tenon's capsule. Corneal healing, recurrence of FK, visual acuity, and relevant complications were reported as outcome measures. ResultsSixteen patients (13 male, 3 female) had a mean age of 58.8 ± 10.3 (range 29–72) years. The mean diameter of corneal perforation was 1.9 ± 0.7 (range 0.5–2.8) mm. Corneal perforations healed and all the patients preserved their eyeballs. During the 11.0 ± 4.4 (range 6–18) months of follow-up, there was no recurrence of FK in any of these cases. Visual acuity improved in 15 eyes (93.8 %) and remained unchanged in 1 patient (6.3 %) who had no light perception when first admitted. All 6 patients who accepted secondary keratoplasty showed improved best corrected visual acuity of more than 4 lines. The most frequently found fungi were Aspergillus species (6 of 16, 37.5 %) and Fusarium species (4 of 16, 25.0 %), followed by 1 Scedosporium apiospermum (1 of 16, 6.3 %). ConclusionsCombination AMT with CFCS is a safe and effective surgery for patients with corneal perforations in FK, particularly where eye banks and fresh corneas are not available. This surgery could preserve the integrity of the eyeball and avoid the recurrence of FK. Besides, it provides a greater opportunity for further optical keratoplasty.

The Outcome of Concurrent Intracameral Fluconazole Injection with Amniotic Membrane Transplantation for Fungal Keratitis in Dr. M. Djamil General Hospital: A Case Series

Background: Fungal keratitis is often difficult to eradicate and requires long treatment. Antifungal agents have lower efficacy because of low tissue penetration and the indolent nature of the infection. Fluconazole has effective ocular penetration ability, reaching aqueous concentration as same as plasm concentration. Multilayer amniotic membrane transplantation (MLAMT) has been shown to be a promising surgical procedure to reconstruct the ocular surface by supporting the epithelialization of the cornea and having protective antimicrobial properties. This study aims to report the outcome of concurrent intracameral fluconazole injection with amniotic membrane transplantation for fungal keratitis in Dr. M. Djamil General Hospital.
 Case presentation: Four inpatients in the ophthalmology ward of Dr. M. Djamil General Hospital with moderate to severe fungal keratitis. All patients were first treated with medications. Because the patients did not show clinical improvement after getting maximum therapy, they underwent intracameral fluconazole injection concurrent with MLAMT. MLAMT was performed with multilayered amniotic membranes to fill and cover the defect. The bandage contact lens was placed to protect and keep the MLAMT in place and for patients’ comfort. Patients were then observed for signs of inflammatory reaction and epithelialization. All patients showed reduced inflammation and improved epithelization after surgery.
 Conclusion: Concurrent intracameral fluconazole injection with MLAMT can be considered an alternative treatment for refractory fungal keratitis as it decreases the rate of inflammation and improves epithelization.

Peripheral Ulcerative Keratitis in Relapsing Polychondritis: An Ophthalmic Challenge

Peripheral ulcerative keratitis (PUK) is an inflammatory condition leading to ocular morbidity. It can be associated with underlying autoimmune diseases which often goes undetected if the ocular manifestation precedes the systemic manifestation. The objective of this case report is to highlight that, the management of such entity is challenging. We present a case of a 36-year- old female with diminution of vision, PUK with necrotizing scleritis in both the eyes for which she was on regular treatment. Along with medications, she underwent multilayered amniotic membrane transplantation and scleral graft. Later on she developed tracheal stenosis and polychondritis for which she underwent tracheostomy. The ocular presentation of relapsing polychondritis can precede the systemic manifestations which may lead to delay in diagnosis and management of the disease. Unless the underlying disease is addressed, ocular morbidity progresses regardless the ocular treatment.

A Challenging Management of Pseudomonas Perforated Corneal Ulcer with Multilayer Amniotic Membrane Transplantation and Pericardial Patch Graft in Pediatric Patient

Introduction: Pseudomonas aeruginosa (P. aeruginosa) is the leading cause of corneal ulcers in children 0 to 3 years of age compared to children in general. Case presentation: A two-months-old infant presented with whitish patches on the right eye two days before admission. A central corneal ulcer with a size of 7-mm x 7-mm accompanied by corneal thinning and melting was shown on the right cornea. It is was surrounded by greyish white creamy infiltrates. Corneal scraping showed Pseudomonas aeruginosa specimens. The cornea became perforate and crystalline lens extrusion was found at the day after intravenous ceftriaxone, levofloxacin eye drop, and cefazoline fortified eye drop administering. It might be caused by bacterial elastase and toxin which contributed to corneal damage. The patient was underwent a multilayer Amniotic Membrane Transplantation (AMT) combined with a pericardial patch graft due to corneal perforation. Two months post-AMT and pericardial patch graft the corneal perforation became entirely heal due to multilayer AMT, despite lysis of the pericardial patch graft. Corneal scar formation and reduction of vitreous opacity in ultrasound examination were shown. The patient was planned to undergo keratoplasty. Conclusions: Corneal ulcers due to Pseudomonas aeruginosa are highly destructive. The levels of infection, diagnostic, and therapeutic are still problems in pediatric patients. Lens extrusion and lysis of the pericardial patch graft are examples in this case. Keratoplasty is the definitive treatment for corneal ulcers with perforation; however, multilayer AMT combined with pericardial patch graft can be used as an alternative therapy to accelerate wound healing, reduce inflammation, and maintain the integrity of the eyeball.

Glueless and Sutureless Multi-Layer Amniotic Membrane Transplantation in a Patient With Pending Corneal Perforation

Ocular graft-versus-host disease (GVHD) is a severe complication of allogenic hematopoietic stem cell transplantation (HSCT). It is a term used to describe a spectrum of signs and symptoms including ocular surface inflammation, dry eye syndrome, lacrimal and meibomian gland dysfunction. We present a case of a 73-year-old man with chronic myeloblastic leukaemia and chronic GVHD. On examination, severe corneal thinning was detected in his left eye. We performed multi-layer amniotic membrane patching of the affected area, in an ambulatory setting, without using sutures or glue, but only a bandage contact lens to keep amniotic membranes attached. Three months post-amniotic-membrane-patching symptoms improved, corneal integrity was maintained, and corneal thickness increased significantly. Multi-layer amniotic membrane patching without glue and sutures may be sufficient enough to prevent further deterioration of corneal thinning and can be safely performed as an outpatient procedure, reducing the need for tectonic corneal transplantation.

Visual Acuity and Number of Amniotic Membrane Layers as Indicators of Efficacy in Amniotic Membrane Transplantation for Corneal Ulcers: A Multicenter Study.

Background: To evaluate new indicators in the efficacy of amniotic membrane transplantation (AMT) for non-healing corneal ulcers (NHCUs). Methods: Retrospective, multicenter study. In total, 223 AMTs for NHCU in 191 patients were assessed. The main outcomes studied were the success rate of AMT (complete re-epithelization), postoperative visual acuity (VA) gain, and number of AM layers transplanted. Results: The overall AMT success rate was 74.4%. In 92% of our patients VA stability or improvement. Postoperative VA was significantly higher than preoperative VA in the entire cohort (p < 0.001) and in all etiological groups of ulcers (post-bacterial, p ≤ 0.001; post-herpetic, p ≤ 0.0038; neurotrophic ulcers, p ≤ 0.014; non-rheumatic peripheral, p ≤ 0.001; and ulcers secondary to lagophthalmos and eyelid malposition or trauma, p ≤ 0.004). Most participants (56.5%) presented a preoperative VA equal to or less than counting fingers (≤0.01). Of these, 13.5% reached a postoperative VA equal to or better than legal blindness (≥0.05) after AMT. A higher success rate was observed in the monolayer than in the multilayer AMT (79.5% and 64.9%, respectively; p = 0.018). No statistically significant values were found between the number of layers transplanted and VA gain (p = 0.509). Conclusion: AMT is not only beneficial in achieving complete re-epithelialization in NHCUs but also in improving postoperative VA; these improvements are independent of etiologies of ulcers. Furthermore, the use of monolayer AMT seems to be a more appropriate option than multilayer AMT for NHCU since the multilayer AMT did not present better outcomes (success rate and VA gain) compared to monolayer AMT in the different types of ulcers studied.

Observation on the efficacy of the drug-soaking amniotic membrane transplantation for bacterial corneal ulceration

Objective To observe the efficacy of the drug-soaking amniotic membrane transplantation(AMT)in the treatment of bacterial corneal ulceration. Methods Prospective, non-comparative series case study. Fifteen eyes of 15 patients with bacterial ulceration were performed single or multilayered AMT. The wound healing time of the corneal ulceration, stromal inflammation subsided and decrease of corneal neovascularization were observed.The follow up time was 6-13 months. Results The stromal inflammation was improved at 7-14 days after surgery. Epithelial defects healed within 14-30 days after surgery. The visual acuity were improved in all patients but the corneal opacity and cataract were not changed. No complication occurred during the follow-up time. Conclusion The drug-soaking AMT for the treatment of bacterial keratitis can reduce dosing frequency, reduce the burden on patients and medical staff. Key words: Amnion, transplantation; Ulceration, corneal, bacterial; Corneal neovascularization

Continuous intraoperative optical coherence tomography-guided shield ulcer debridement with tuck in multilayered amniotic membrane transplantation.

Purpose:The aim of this study is to describe a modified surgical technique of continuous intraoperative optical coherence tomography (iOCT)-guided shield ulcer debridement with tuck-in multilayered Amniotic membrane transplantation (ML AMT) in vernal keratoconjunctivitis (VKC) with shield ulcer with plaque.Methods:Seven eyes of seven patients presenting with VKC with shield ulcer with plaque were enrolled in this prospective case series and planned for shield ulcer debridement with ML AMT. Debridement of the ulcer base with double-layered AMT was done under the continuous guidance of iOCT. The main outcome measure was the time for complete reepithelialization. Statistical analysis was performed using the Stata-14.0 program for Windows. Data were presented as mean ± standard deviation/median (minimum-maximum) and frequency percentage as applicable.Results:The surgery could be completed successfully in all cases and iOCT could provide real-time assessment of the depth of dissection during the entire procedure. The duration of complete healing and disintegration of amniotic membrane varied from 7 to 12 days. Recurrence was not seen in any case till 2 months follow-up.Conclusion:iOCT provides continuous monitoring of the depth of dissection and allows for a safe and complete debridement of the shield ulcer with plaque.

Transparent, resilient human amniotic membrane laminates for corneal transplantation

This study evaluated a new technique to toughen and optically clarify human amniotic membrane (AM) tissue, which is naturally thin and clouded, and determined the suitability of the altered tissue for corneal transplantation. The technique created a tissue laminate by repeatedly depositing wet layers of AM and dehydrating them, followed by chemical cross-linking to tighten integration at the layer interfaces and within the layers, thereby improving the physical properties of the laminates by increasing light transmittance and mechanical strength. Interestingly, this improvement only occurred in laminates with at least 4 layers. Cross-linking also improved the resistance of the laminates to collagenase degradation, such as occurs in corneal melting. This study also confirmed that the AM tissue was biocompatible by inserting AM monolayers into the corneal stroma of rabbits, and by performing lamellar keratoplasty in rabbits with cross-linked AM laminates. The laminates were sufficiently thick and resilient to need only one set of sutures, whereas in previously described multi-layer AM transplantation technique, each layer required separate sutures. The current findings are a promising advance in the engineering of novel biomaterials and the alteration of existing tissues for medical use.

Role of multilayered amniotic membrane transplantation for the treatment of resistant corneal ulcers in North India

To study the role of multilayer amniotic membrane transplantation (AMT) in the treatment of non-healing corneal ulcers. This study included 28 patients with non-healing bacterial corneal ulcers. AMT was performed using the 'overlay on-inlay' technique'. The outcome was assessed in terms of best corrected visual acuity (BCVA), corneal re-epithelization, graft/tissue edema and vascularity, graft melting, graft retraction, infection of graft and surface necrosis. The success rate of ulcer healing was 82.1 % (23 patients) 1 month after surgery, 78.5 % (22 patients) after 3 months and 75 % (21 patients) after 6 months. In the early post-operative period, BCVA deteriorated in all patients (perception of light to hand movement) but improved later. In 26 of the 28 patients (92.8 %) graft retraction occurred after 1 month and neovascularization was seen in 17 of the 28 patients (60.7 %). Multilayer AMT using an overlay on-inlay graft in non-healing bacterial corneal ulcers is a good option in terms of ulcer healing and symptomatic improvement.

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.

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.

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.

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.

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.