Multilayer amniotic membrane transplantation in the treatment of corneal perforations.
OBJECTIVE
To determine if multilayer amniotic membrane transplantation (AMT) is useful in the treatment of corneal perforations, and in particular to assess to what extent efficacy is affected by perforation size.


METHODS
Fifteen patients (15 eyes) with corneal perforations of different sizes were divided into 3 groups: group A (microperforation, 6 eyes), group B (0.5-1.5 mm, 4 eyes), and group C (>1.5 mm, 5 eyes). The corneal perforation was caused by autoimmunity-related ulcer (3 eyes), neurotrophic ulcer (9 eyes), infectious keratitis (1 eye), or postkeratoplasty ulcer (2 eyes). Two layers of AM (for microperforations) or 3-4 layers (for the other groups) were trimmed to the size of the ulcer and sutured in place with interrupted 10-0 nylon sutures. In all cases, a bandage contact lens was then applied.


RESULTS
Mean epithelialization time was 3.7 weeks (range 2-6). Mean time to recovery of corneal stroma thickness was 10.1 weeks (range 7-15). In all cases, ocular inflammation subsided within 2-5 weeks. The treatment was judged successful in 73% (11/15) of eyes. Three of the 4 unsuccessful treatments were of perforations 3 mm or more in diameter; of the 5 eyes with perforations of more than 1.5 mm in diameter, only 2 were treated successfully.


CONCLUSIONS
These results suggest that multilayer AMT is effective for treating corneal perforations with diameter less than 1.5 mm. The technique may be a good alternative to penetrating keratoplasty, especially in acute cases in which graft rejection risk is high.
Rodríguez-Ares
M Teresa
MT
Anterior Segment Unit, Department of Ophthalmology, Hospital de Conxo-Complejo Hospitalario Universitario de Santiago, Universidad de Santiago de Compostela, Spain. trares@usc.es
Touriño
Rosario
R
López-Valladares
M Jesús
MJ
Gude
Francisco
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000650:Amnion / Q000637:transplantation*; D001684:Biological Dressings; D003315:Cornea / Q000473:pathology / Q000601:surgery*; D003320:Corneal Ulcer / Q000473:pathology / Q000601:surgery*; D019573:Epithelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012422:Rupture, Spontaneous; D014945:Wound Healing