Five-Layered Reinforcing Amniotic Membrane Transplantation for Treatment of Deep Corneal Ulcer or Perforation

Doo Hwan Oh; Min Seok Kwon; Jae Chan Kim

doi:10.3341/jkos.2011.52.10.1232

Journal List > J Korean Ophthalmol Soc > v.52(10) > 1008910

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Oh, Kwon, and Kim: Five-Layered Reinforcing Amniotic Membrane Transplantation for Treatment of Deep Corneal Ulcer or Perforation

Original Article

J Korean Ophthalmol Soc 2011;52(10):1232-1237.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.10.1232

Five-Layered Reinforcing Amniotic Membrane Transplantation for Treatment of Deep Corneal Ulcer or Perforation

Doo Hwan Oh, MD, Min Seok Kwon, MD, Jae Chan Kim, MD, PhD

Department of Ophthalmology, Chung-Ang University College of Medicine, Seoul, Korea

Address reprint requests to Jae Chan Kim, MD, PhD Department of Ophthalmology, Chung-Ang University Hospital #224-1 Heukseok-dong, Dongjak-gu, Seoul 156-755, Korea Tel: 82-2-6299-1665, Fax: 82-2-825-1666, E-mail: jck50ey@kornet.net

Received 17 August 2010 Accepted 7 March 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the efficacy of five-layered reinforced amniotic membrane (AM) transplantation for treating deep corneal ulcer or perforation.

Case summary

We performed a five-layered reinforced AM transplant in three cases of corneal ulceration or perforation using mechanical compressed lyophilized AMs. In all cases, the perforated cornea healed with reepithelization within 2 weeks and the ocular surface was stabilized for more than 1 year.

Conclusions

Five-layered reinforced AM transplantation may be an alternative method for treating deep corneal ulcers or perforations.

Keywords: Amniotic membrane, Corneal perforation, Corneal ulcer

References

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Figure 1.

Light microscopic findings of amniotic membrane. (A) Single-layered lyophilized AM, (B) 5-layered reinforced AM (hematoxylin-eosin, original magnification, ×200). AM = amniotic membrane.

Figure 2.

Case 1 (A) Initial photographs. The cornea was perforated and the anterior chamber was shallow. (B) Anterior chamber was well formed and no epithelial defects were seen 18 months after 5-layered reinforcing AM trasplantation. Case 2 (C) Initial photographs. Corneal ulcer (2 × 3 mm) with peripheral opacity was seen preoperatively. (D) The ocular surface was stabilized until postoperative 5 months. Case 3 (E) Initial photographs. Corneal ulcer (5 × 5 mm) and total limbal deficiency with neovascularization were seen. (F) To prevent complication of exposure keratitis, tarsorrhaphy has been maintained until post operative 15 months.

Figure 3.

Representative AS-OCT imaging of case 2. Recovery of corneal thickness and anterior chamber stability was showed with AS-OCT at 12 months after 5-layered reinforced AM transplantation. AS-OCT = anterior segment Optical coherence tomography; AM = amniotic membrane.

Table 1.

Characteristics and clinical outcomes of patients receiving transplantation of 5-layered reinforced AM for corneal perforation or ulceration

Case	Sex/Age	Disease	Operation	Epithelial healing (day)	BCVA		f/u (mon)	Postop. status
Case	Sex/Age	Disease	Operation	Epithelial healing (day)	Preop.	Final	f/u (mon)	Postop. status
1	M/78	Corneal perforation	Transplantation of 5-layered reinforcing AM	14	FC. 30 cm	0.1	18	Stabilized ocular surface
2	M/41	Corneal ulceration	Transplantation of 5-layered reinforcing AM	6	0.3	0.5	12	Stabilized ocular surface
3	F/88	Corneal ulceration	Transplantation of 5-layered reinforcing AM, Permanent tarsorraphy	14	LP (−)	Can't check	15	Stabilized ocular surface

AM = amniotic membrane; FC = finger count; LP = light perception; BCVA = best corrected visual acuity; f/u = follow up.

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