Amniotic membrane transplantation for persistent corneal ulcers and perforations in acute fungal keratitis.
OBJECTIVE
To report the therapeutic effect and complications of amniotic membrane transplantation (AMT) in acute fungal keratitis.


METHODS
Diagnosis of fungal keratitis was confirmed by cultures in 23 eyes of 23 patients. The indications to perform AMT were to promote reepithelialization in non-healing ulcers or to prevent corneal perforation. Antifungal agents were administered throughout the whole course of hospitalization. Repeated cultures were performed immediately before AMT. The main outcome measurements were epithelial healing rate, necessity of therapeutic penetrating keratoplasty (TPK), and persistence of infection.


RESULTS
During a mean follow-up time of 20.6 months +/- 23.22 (6-65 months) AMT was performed during the active phase of the keratitis (fungal culture was still positive) in 16 patients (69.6%), and during the inactive phase (fungal culture negative) in 7 patients (30.4%). Single-layer AMT was performed in 17 patients, and double-layer AMT was performed in 6 patients with corneal perforation and anterior chamber collapse. Complete epithelialization was observed in 12 patients (75%) in the active group and in 7 patients (100%) in the inactive group. Treatment failure requiring TPK was experienced in 4 patients (25%) in the active group. Persistent fungal keratitis was noted in 2 patients (8.7%) in that group. The final visual acuity improved in 17 cases, worsened in 2 cases, and remained unchanged in 4 cases. Twelve of the 23 eyes (52.2%) in this study preserved useful vision (20/400 and better) with or without subsequent surgeries.


CONCLUSIONS
AMT is effective in promoting epithelialization and preventing corneal perforations in acute fungal keratitis, and there is no risk of rejection. However, the risk of persistent or recurrent infection necessitates continued antifungal treatment and patient monitoring.
Chen
Hung-Chi
HC
Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Tan
Hsin-Yuan
HY
Hsiao
Ching-Hsi
CH
Huang
Samuel Chao-Ming
SC
Lin
Ken-Kuo
KK
Ma
David Hui-Kang
DH
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000650:Amnion / Q000637:transplantation*; D000935:Antifungal Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003320:Corneal Ulcer / Q000382:microbiology* / Q000503:physiopathology / Q000601:surgery*; D019573:Epithelium, Corneal / Q000502:physiology; D015821:Eye Infections, Fungal / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000382:microbiology / Q000601:surgery*; D012422:Rupture, Spontaneous / Q000517:prevention & control; D017211:Treatment Failure; D016896:Treatment Outcome; D014792:Visual Acuity; D014945:Wound Healing / Q000502:physiology
D000935:Antifungal Agents