Multilayered amniotic membrane transplantation for severe ulceration of the cornea and sclera

ELSEVIER, Hanada, K; Shimazaki, J; Shimmura, S; Tsubota, K, AMERICAN JOURNAL OF OPHTHALMOLOGY, 131(3), 324-331, 2001. authorObjective: To examine the efficacy of amniotic membrane transplantation in the treatment of deep corneal and scleral ulcers. Design: Retrospective, noncomparative case series. Participants: A total of 11 patients were recruited for this study: four patients (4 eyes) with corneal perforation, 5 patients (5 eyes) with a deep corneal ulcer and descemetocele, and 2 patients (2 eyes) with a scleral ulcer. Intervention: Ulcers were treated by amniotic membrane transplantation. Separate amniotic membranes (AM) were transplanted as materialto fill the stromal layer (AM filling), as a basement membrane (AM graft), and as a wound cover (AM patch). After surgery, all cases were treated with artificial tears, autologous serum drops, antibiotic eyedrops, topical steroids, and sodium hyaluronate eyedrops.Main outcome measures: Repair of ulcer and/or perforation. Results: Eight eyes (72.7%) healed with epithelialization in 16.5 8.0 days, with 5 and 3 eyes showing corneal epithelialization and conjunctival epithelialization, respectively. A persistent epithelial defect was noted in 1 eye with corneal ulcer after limbal allograft transplantation for a chemical burn and in 2 eyes with corneal ulcers as a a complication of rheumatoid arthritis. Conclusion: Multilayered amniotic membrane transplantation is effective for the treatment of deep ulceration of the cornea and sclera. Some cases may be complicated by the presence of corneal limbal dysfunction or immunological problems