title: Amniotic membrane grafts for nontraumatic corneal perforations, descemetoceles, and deep ulcers.
abstract: OBJECTIVE
  To describe the clinical outcome of amniotic membrane transplantation (AMT) for nontraumatic corneal perforations, descemetoceles, and deep ulcers.
  
  
  METHODS
  Retrospective, noncomparative, interventional case series.
  
  
  METHODS
  Thirty-four eyes of 33 consecutive patients operated on for nontraumatic corneal perforations or descemetoceles at four academic departments of ophthalmology. Associated autoimmune disorders included rheumatoid arthritis (n = 6), Stevens-Johnson syndrome (n = 3), ocular cicatricial pemphigoid (n = 2), systemic lupus erythematosus (n = 1), and one eye with Mooren's ulcer, as well as neurotrophic, or exposure keratopathy (n = 10), postinfectious nonhealing ulcers (n = 6), and postsurgery (n = 5).
  
  
  METHODS
  Three or four layers of amniotic membrane (AM) were applied over the ulcer bed and anchored with 10-0 nylon interrupted or running sutures. A large AM piece was used as a patch to cover the entire corneal surface.
  
  
  METHODS
  Formation of anterior chamber depth, epithelialization of the AM grafts, and stability of the corneal stromal thickness.
  
  
  RESULTS
  The mean follow-up period was 8.1 +/- 5.7 (ranging from 2-23) months. A successful result was observed in 28 of 34 eyes (82.3%). Of the successful cases, 23 eyes needed one AMT procedure, whereas 5 eyes needed two procedures to achieve a successful result. In five eyes, a subsequent definitive surgical procedure such as penetrating keratoplasty or lid surgery was needed. Failure was observed in six eyes with rheumatoid arthritis, neurotrophic keratopathy, or graft melting.
  
  
  CONCLUSIONS
  AMT is an effective method for managing nontraumatic corneal perforations and descemetoceles. It can serve as either a permanent therapy or as a temporizing measure until the inflammation has subsided and a definitive reconstructive procedure can be performed. This treatment option is also beneficial in those countries where corneal tissue availability is limited.
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA.
authors.forename: Abraham
authors.initials: A
authors.lastname: Solomon
authors.forename: Daniel
authors.initials: D
authors.lastname: Meller
authors.forename: Pinnita
authors.initials: P
authors.lastname: Prabhasawat
authors.forename: Thomas
authors.initials: T
authors.lastname: John
authors.forename: Edgar M
authors.initials: EM
authors.lastname: Espana
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Steuhl
authors.forename: Scheffer C G
authors.initials: SC
authors.lastname: Tseng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000650:Amnion / Q000637:transplantation*; D002648:Child; D003316:Corneal Diseases / Q000473:pathology / Q000601:surgery*; D003320:Corneal Ulcer / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000473:pathology / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome