Symptomatic Bullous Keratopathy Research Articles

Palliative Efficacy of Intrastromal Amniotic Membrane Procedure in Symptomatic Bullous Keratopathy Patients.

Objectives:To evaluate the palliative efficacy of the intrastromal human amniotic membrane (hAM) surgery technique in patients with symptomatic bullous keratopathy and limited visual potential.Materials and Methods:The study was carried out retrospectively by reviewing the medical data of 10 patients with poor visual prognosis who underwent intrastromal hAM surgery due to bullous keratopathy-related severe pain. Visual acuity, surgical indication, epithelization time, preoperative and postoperative pain scores, as well as anterior segment optical coherence tomography images and anterior segment photographs were obtained from the medical records.Results:Ten patients (6 females/4 males) were included in the study. Nine patients underwent surgery for pseudophakic bullous keratopathy and glaucoma, and 1 patient due to graft failure and glaucoma. The mean time for corneal epithelization was 27.10±13.05 days (range, 10-50), while the mean follow-up time was 37.5±1.6 months (range, 36-39.2). Subjective pain score improved in all patients after surgery. Suture-induced keratitis occurred during follow-up in one patient and was controlled with medical treatment.Conclusion:Intrastromal amniotic membrane surgery may be an alternative to keratoplasty for pain palliation in patients with limited visual prognosis after corneal transplantation when donor tissue is scarce. With this method, hAM remains on the ocular surface longer, and superficial stromal excision is believed to provide a more regular ocular surface and extend the asymptomatic period.

Palliative Efficacy of Intrastromal Amniotic Membrane Procedure in Symptomatic Bullous Keratopathy Patients

Palliative Efficacy of Intrastromal Amniotic Membrane Procedure in Symptomatic Bullous Keratopathy Patients

Long-Term Outcomes of Phototherapeutic Keratectomy for Bullous Keratopathy.

To report the long-term outcomes after phototherapeutic keratectomy (PTK) for the treatment of bullous keratopathy. This is a retrospective medical record review of all patients with symptomatic bullous keratopathy who underwent PTK between June 2005 and March 2019 at the Royal Victorian Eye and Ear Hospital who were followed up for at least 12 months after the procedure. Medical records were used to extract demographic data, etiology of bullous keratopathy, complication rates, and subsequent procedures after PTK. The main outcomes recorded were pain and recurrence of bullae, which were assessed according to three time periods: 0 to 3 months, 4 to 12 months, and greater than 12 months after PTK. During the study period, 64 eyes of 64 patients underwent PTK for bullous keratopathy. The mean follow-up duration was 51 months (range 12-140). The most common indication was pseudophakic bullous keratopathy (44% of cases). Pain had resolved in 88% of eyes within 0 to 3 months, 77% of eyes between 3 and 12 months (P = 0.031, compared with 0-3 months), and 70% of eyes with greater than 12-month follow-up (P = 0.131, compared with 3-12 months). Bullae recurred in 17% of eyes within 0 to 3 months, 22% of eyes between 3 and 12 months (P < 0.001 compared with 0-3 months), and 33% of eyes after the 12-month follow-up (P < 0.001 compared with 3-12 months). Eighty-six percent of patients undergoing PTK had no postoperative complications, and 73% of cases did not require subsequent procedures. PTK is effective in providing long-term symptom relief from bullous keratopathy in most of the treated patients.

Amniotic Membrane Transplant for Bullous Keratopathy: Confocal Microscopy & Anterior Segment Optical Coherence Tomography

ABSTRACTPurpose: To assess amniotic membrane retention after amniotic membrane transplant in bullous keratopathy patients and whether there were any corneal structural changes that may hinder further penetrating keratoplastyMethods: A retrospective study including 22 patients who have undergone amniotic membrane transplant from 1 Jan 1998 till 30 Jun 2016. Confocal microscopy and anterior segment optical coherence tomography (ASOCT) were performed to assess the retention of amniotic membrane and to detect any corneal structural changes. The comparison was made with 5 controls who had bullous keratopathy awaiting endothelial keratoplasty.Results: Patients had a mean follow-up of 61 ± 33.7 months. Pain reduction was significant (p < .001) although it did not significantly correlate with the regularity of the superficial, intermediate or basal epithelial layers, nor with the retention of the amniotic membrane. No long-term structural changes that may hinder future penetrating keratoplasty were detected.Conclusion: This procedure is a safe and effective long-term treatment for symptomatic bullous keratopathy patients.

Corneal Tattooing and Anterior Stromal Puncture for Treating Symptomatic Bullous Keratopathy.

To investigate the efficacy of corneal tattooing, through anterior stromal puncture (ASP), for managing painful bullous keratopathy (BK). This retrospective, case-controlled, consecutive case series study was performed at a university-based referral clinic. Patients with painful BK who underwent corneal tattooing with Chinese ink between 2007 and 2013 were included in analyses. Patients diagnosed with symptomatic BK who only underwent ASP during the same period were included as a control group. A total of 40 patients (27 men, 13 women) with a mean age of 57.5 ± 15.3 years were included in analyses. The clinical diagnosis was pseudophakic BK in 5 subjects (12.5%), failed graft in 11 subjects (27.5%), BK secondary to perforating corneal injury repair in 19 subjects (47.5%), and end-stage glaucoma in 5 subjects (12.5%). Subjects were followed for a mean period of 26.4 ± 7.5 months (range: 6-55 months). Recurrent bullae formation occurred in 3 of 31 patients (9.68%) who had undergone corneal tattooing and in all 9 patients (100%) who had undergone ASP (P < 0.001). Corneal tattooing with Chinese ink is a simple, effective outpatient procedure for treating painful BK in eyes with no visual potential.

Long-term symptomatic relief of bullous keratopathy with amniotic membrane transplant.

The purpose of this study was to assess the long-term outcome of patients with symptomatic bullous keratopathy after amniotic membrane transplant. A retrospective cohort study includes that 20 patients with symptomatic bullous keratopathy, who have underwent amniotic membrane transplant at the Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital & Alice Ho Miu Ling Hospital, Hong Kong between 04/1998 and 06/2011, were invited back. Clinical examination was performed, including, pain score assessment (pain score out of 10), epithelial healing, and vision. A total of 21 eyes of 20 patients returned for our study. The majority of eyes experienced pain reduction (94 %), with a significant mean pain score difference of 6.8 ± 2.6, 2-tail p < 0.001 (99 % CI 4.9-8.7). The mean pre-operative and post-operative pain scores were 7.3 ± 2.9 and 0.5 ± 1.0, respectively. 16 eyes (76 %) were completely pain free, and 10 eyes (47 %) remained symptom free after a mean follow-up of 39.0 ± 36.3 months (range 5-171 months). The median epithelial healing time was 2 weeks (range 1-20 weeks). Amniotic membrane transplant may be considered as a longer-term treatment for bullous keratopathy patients, especially in patients with poorer visual prognosis, but it may also be used as an interim measure for patients awaiting corneal transplant.

Outcomes of Corneal Collagen Crosslinking in Pseudophakic Bullous Keratopathy

The aim was to evaluate the outcomes of corneal collagen crosslinking (CXL) in symptomatic pseudophakic bullous keratopathy (PBK). In a retrospective noncomparative, interventional case series, we reviewed the records of 50 eyes (50 patients) with symptomatic PBK who underwent CXL. Central corneal thickness (CCT), pain score, best corrected visual acuity (BCVA), and corneal transparency were recorded at baseline; at day 7, day 15; and 1, 3, and 6 months after the CXL. The mean pain score decreased from 8.1 ± 0.6 at presentation to 2.1 ± 0.7 on day 7 (P = 0.0001). A subsequent regression was seen in pain scores over 6 months (5.3 ± 1.5). The mean CCT decreased from a preoperative value of 724.8 ± 78.4 to 694.9 ± 77.9 μm by the end of the first month (P = 0.0001). The CCT remained stable at subsequent follow-up. The BCVA improved from logarithm of the minimum angle of resolution (log MAR) 2.0 ± 0.5 preoperatively to log MAR 1.8 ± 0.5 by the end of the first month (P = 0.001). The subsequent follow-up showed a progressive deterioration in the BCVA to the preoperative levels at 6 months. Corneal bullae recurred in 44% (22 eyes) at 6 months after an initial disappearance. A significant improvement in the BCVA and a lack of recurrence of bullae were significantly associated with a thinner CCT on presentation. CXL in symptomatic PBK temporarily improves pain without providing long-term improvement in the BCVA. Case selection is important with more effect seen in patients with a thinner CCT at presentation.

Comparative Analysis of Human Amniotic Membrane Graft versus Contact Lenses in Symptomatic Bullous Keratopathy

Bullous Keratopathy (BK) is a corneal disease involving the production of vesicles, chronic eye pain and visual acuity decrease. Definitive treatment is corneal transplant; however, donated corneas are not always available, and may require a long waiting time. The available palliative treatment is the use of contact lenses, however, this may be associated with corneal neovascularization, lens displacement or loss, infections and discomfort for the patient. Amniotic membrane is a structure obtained from human placenta that has been used in ophthalmology and more recently in novel regenerative medicine approaches mainly for its anti-inflammatory and anti-fibrotic properties, amongst other biological properties. This study compares the use of amniotic membrane grafts versus contact lenses in patients suffering from BK who are waiting for a corneal transplant. A randomized clinical trial study was performed with patients with diagnosis of BK. Twenty patients were randomized into 2 groups: patients treated with amniotic membrane and treated with therapeutic contact lenses. Eye pain intensity (analog visual scale), visual acuity (Snellen test); bullae, corneal epithelial defects, corneal neovascularization and complications (biomicroscopy) were compared during 6 months. In the amniotic membrane-treated group the ocular pain was significantly lower after 7 days (p=0.005) and 30 days (p=0.002) from the surgical procedure as compared to therapeutic contact lenses group, but it increased at day 180 (p=0.042). No statistical differences were observed for the other parameters evaluated. Amniotic membrane is a safe and efficient alternative to the therapeutic contact lenses to short term relief of ocular pain in patients with BK.

Amniotic membrane transplantation versus anterior stromal puncture in bullous keratopathy: a comparative study

PurposeTo compare amniotic membrane transplantation (AMT) and anterior stromal puncture (ASP) in the management of pain in patients with symptomatic bullous keratopathy (BK).MethodsIn this prospective comparative study, 40 eyes of...

Phototherapeutic Keratectomy with or without Amniotic Membrane Transplantation for Symptomatic Bullous Keratopathy

Phototherapeutic Keratectomy with or without Amniotic Membrane Transplantation for Symptomatic Bullous Keratopathy

Treatment of Symptomatic Bullous Keratopathy With Poor Visual Prognosis Using a Modified Gundersen Conjunctival Flap and Amniotic Membrane

A modified Gundersen conjunctival flap combined with amniotic membrane to treat symptomatic bullous keratopathy and poor visual prognosis is described. A 360° conjunctival peritomy was performed 2 mm from the limbus. After complete epithelial removal of the corneo-conjunctival surface, an amniotic membrane graft was sutured at the peripheral cornea with a running 10-0 nylon suture. Single 9-0 polyglactin sutures attached the edges of the amniotic membrane with the peritomized conjunctiva, which lay over the amniotic membrane. Five eyes were treated. Epithelialization, resolution of the pain, presence of ocular surface inflammation, and reinterventions were assessed. All eyes showed immediate resolution of the pain and minimal inflammation. In 1 eye, the amniotic membrane was reabsorbed before complete epithelialization. No reinterventions were required. All eyes were asymptomatic for at least 16 months. This technique provided sustained relief of symptomatic bullous keratopathy while significantly reducing the conjunctival manipulation and the anatomical distortion associated with classic sliding conjunctival flaps.

Descemet Stripping Automated Endothelial Keratoplasty for Spontaneous Descemet Membrane Detachment in a Patient With Osteogenesis Imperfecta

To report the first use of Descemet stripping automated endothelial keratoplasty (DSAEK) for spontaneous Descemet membrane detachment in a patient with osteogenesis imperfecta (OI), keratoconus, and acute bullous keratopathy. A case report of a 25-year-old man with OI and symptomatic unilateral bullous keratopathy secondary to spontaneous Descemet membrane detachment is described. The patient presented with acute loss of vision in his right eye and was noted on slit-lamp examination to have a totally detached and taut Descemet membrane, spanning the anterior chamber. This diagnosis was confirmed with an anterior segment OCT (Visante; Carl Zeiss Meditec, Dublin, CA). After an attempt to reattach the Descemet membrane with air bubbling was unsuccessful, the patient underwent successful DSAEK. Seven months postoperatively, his best spectacle-corrected visual acuity was 20/50 compared with his other eye, which was 20/40. There were some central folds in the donor noted immediately postoperatively that have persisted. To the best of our knowledge, this case is the first documented spontaneous Descemet membrane detachment in a patient with OI and probable keratoconus treated successfully with DSAEK. Unlike in classical keratoconus hydrops, medical management is unlikely to resolve a total Descemet membrane detachment. This unusual Descemet membrane detachment was tightly stretched across the anterior chamber without any obvious tear, making simple air or gas bubble apposition impossible. Attempts to tear the Descemet membrane and then bubble led to significant folds. DSAEK was successful in removing the detached Descemet membrane and replacing it with the donor tissue.

Combined Phototherapeutic Keratectomy and Amniotic Membrane Grafts for Symptomatic Bullous Keratopathy

*Department of Ophthalmology Baba Deep Singh Charitable Hospital Amritsar, Punjab, India; and †Government Medical College Amritsar, Punjab, India.

Comparative Evaluation of Phototherapeutic Keratectomy and Amniotic Membrane Transplantation for Management of Symptomatic Chronic Bullous Keratopathy

To compare the efficacy and safety of phototherapeutic keratectomy (PTK) and amniotic membrane transplantation (AMT) for symptomatic relief in painful bullous keratopathy. Twenty-five eyes of 25 patients with symptomatic bullous keratopathy and poor visual potential were randomized into 2 groups. In the PTK group (n = 13) after manual epithelial debridement, 100-microm excimer laser ablation was performed. In the AMT group (n = 12), the corneal epithelium was scraped and cryopreserved amniotic membrane with basement membrane side up was secured with 10-0 monofilament nylon sutures. All patients were followed up for at least 6 months. Outcome parameters included symptomatic relief, time taken for surface reepithelialization, change in corneal thickness, and complications. At 6-month follow-up, a significant decrease was seen in the symptom scores from the baseline level in both the PTK and AMT groups (P = 0.011 and 0.017, respectively) with no difference between the groups (P = 0.593). Complete epithelialization was noted 2 weeks postoperatively in 13 of 13 eyes in the PTK group as compared with 8 of 12 eyes in the AMT group (P = 0.023). However, this difference was not significant at the end of 3 weeks (P = 0.288). One eye in the AMT group developed Staphylococcus epidermidis keratitis. Both PTK and AMT are comparable in providing symptomatic relief in patients with bullous keratopathy and poor visual potential.

Sutureless Amniotic Membrane Fixation with Fibrin Glue in Symptomatic Bullous Keratopathy with Poor Visual Potential

Sutureless Amniotic Membrane Fixation with Fibrin Glue in Symptomatic Bullous Keratopathy with Poor Visual Potential

Impression cytology findings in bullous keratopathy

AimTo evaluate, by impression cytology (IC), the cytological features of the central area of corneal epithelial surface of patients with symptomatic bullous keratopathy (BK).DesignCross-sectional observational case series.MethodsIC of the central...

Letter to Editor: Sutureless amniotic membrane fixation with fibrin glue in symptomatic bullous keratopathy with poor visual potential and Author's reply.

Letter to Editor: Sutureless amniotic membrane fixation with fibrin glue in symptomatic bullous keratopathy with poor visual potential and Author's reply.

Combined Phototherapeutic Keratectomy and Amniotic Membrane Grafts for Symptomatic Bullous Keratopathy

The purpose of this study was to investigate the outcome of combined phototherapeutic keratectomy and amniotic membrane grafting in the management of painful symptomatic bullous keratopathy. We conducted a retrospective consecutive interventional case series. Combined phototherapeutic keratectomy and amniotic membrane grafting was performed in 18 eyes of 17 patients who were symptomatic because of bullous keratopathy. Data analysis was done for only 12 eyes that were followed up for more than 5 weeks and when the postoperative status of the amniotic membrane was known. The mean preoperative duration of the symptoms was 164.17 +/- 179.39 weeks (range, 24-480 weeks). Eleven of 12 eyes (91.67%) were totally symptom-free during the entire postoperative follow-up period of 38.08 +/- 47.95 weeks (range, 5-156 weeks). One patient (8.33%) had mild irritation, which had started at his last postoperative follow up, at 8 months. His amniotic membrane had absorbed at 16 weeks. The amniotic membrane was completely absorbed in 58.33% (7 of 12 eyes) of eyes, partially absorbed in 33.33% eyes (4 of 12 eyes), and not absorbed at all in one eye (8.33 %). None of the patients required any repeat or additional procedure. Phototherapeutic keratectomy when combined with amniotic membrane grafting provides a viable alternative in the management of painful symptomatic bullous keratopathy.

Efeito terapêutico do "cross-linking" corneano na ceratopatia bolhosa sintomática

To evaluate the corneal cross-linking (CXL) effect on symptomatic bullous keratopathy, and its impact on the visual acuity, corneal thickness and pain symptomatology. Twelve patients with symptomatic bullous keratophaty were included. A clinical examination with a specific questionnaire (pain scale-visual numeric analog scale), visual acuity, and corneal thickness measures was performed before corneal cross-linking and 7, 30 and 60 days after the procedure. In all patients, the treatment with the UVA-crosslinking was done after corneal abrasion on the slit-lamp and instillation of 0.1% riboflavin in saline for every five minutes, lasting 30 minutes. Subsequently, the patient underwent the UVA light exposure, using riboflavin and topical anesthesia, every five minutes lasting 30 minutes. The patient received 0.3% ofloxacine drops, and artificial tears until complete reepithelization. The Friedman test was used to compare the means of frequencies of visual acuity, pain symptoms and corneal thickness. A 'p' value<0.05 was considered for rejecting the null hypothesis. Twelve eyes from 12 patients with recurrent epithelium erosions were treated. The mean follow-up was two months. Significant pain reduction was observed (p<0.001). Corneal thickness and visual acuity measurements presented with no significant difference. The potential use of cross-linking in the treatment of bullous keratopathy pain was proved to be likely. A longer follow-up to confirm whether these results can be reproduced in the long term is necessary.

Prospective Comparison of Two Suturing Techniques of Amniotic Membrane Transplantation for Symptomatic Bullous Keratopathy

To determine the outcomes of a modified amniotic membrane transplantation (AMT) suturing technique for pain and discomfort relief in patients with symptomatic bullous keratopathy (BK). Randomized, double-blind controlled clinical trial. setting: Ankara Research and Training Hospital 1st and 2nd Eye Clinics, Ankara, Turkey. study population: This prospective study included 39 eyes (39 patients) with BK presenting with intractable pain or discomfort and poor visual potential. intervention: Patients were randomly assigned into two groups: in group 1 (21 patients), patients underwent a modified AMT suturing technique; a groove was prepared by vacuum trephine on the recipient cornea and the edges of the punch-shaped amniotic membrane (AM) were sutured to this groove with the basement membrane side up. In group 2 (18 patients), patients underwent the standard AMT suturing to the cornea. main outcome measure: During a mean follow-up of 27.3 +/- 8.5 months (standard deviation) (range, 12 to 36 months), epithelial healing, persistence of AM, pain relief, and visual changes were analyzed and were compared between groups. The mean age (P = .15), the mean follow-up (P = .73), and the mean preoperative visual acuity (P = .53) were similar in both groups. With the modified suturing technique, the postoperative visual acuity was better (P = .03), epithelialization time was shorter (P < .001), and the AM remained longer (P < .001). Successful epithelialization was achieved in 20 eyes (95.3%) in group 1, and in 16 eyes (88.9%) in group 2 (P = .586). The pain scores of patients in group 1 remained stable (P = .223) over time, however increased from the first week to the third month postoperatively in group 2 (P = .046). The modified AMT suturing technique has a similar epithelialization rate to standard AMT suturing to cornea. Though technically more demanding, shorter epithelialization time, longer persistence of AM, and stable pain scores in the postoperative period makes this a promising method for the treatment of symptomatic BK.