Amniotic membrane transplantation in severe bacterial keratitis.
OBJECTIVE
To determine whether a combination of early amniotic membrane transplantation (AMT) and early topical corticosteroid treatment could be a safe adjuvant therapy during antibacterial treatment in severe bacterial keratitis (BK) for relieving pain, avoiding iatrogenic epithelial toxicity, and allowing earlier use of topical steroids.


METHODS
In a prospective noncomparative case series, 12 patients with severe microscopically-proven BK were treated with immediate maximal topical antibiotics followed by AMT at 48 hours (single-layer epithelial side-down or multilayer epithelial side-up), plus topical steroid treatment at 72 hours. Pain relief (NRS-11 numeric rating pain scale) and the corneal epithelium healing were measured.


RESULTS
The follow-up rate was 7.5 person-months, with AMT performed once in 2 patients and twice in 10 patients with BK caused by Pseudomonas aeruginosa (5), Klebsiella pneumoniae (1), Moraxella cattharalis (1), Staphylococcus aureus (1), Staphylococcus epidermidis (2), or Streptococcus pneumoniae (1). A significant decrease in the pain score was noted from the admission day (median, 8; range, 7-10) to shortly after AMT (at day 3: median, 2; range, 1-3). Epithelial healing was achieved between 8 and 45 days (mean, 25.5 +/- 9.7 days). Neither perforation nor neovascularization was observed.


CONCLUSIONS
Early AMT combined with topical corticosteroid in severe BK provides immediate pain relief and allows epithelial healing.
Gicquel
Jean-Jacques
JJ
Department of Ophthalmology, CHU Jean Bernard, Poitiers, France.
Bejjani
Riad A
RA
Ellies
Pierre
P
Mercié
Martial
M
Dighiero
Paul
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000583:Amikacin / Q000627:therapeutic use; D000650:Amnion / Q000637:transplantation*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002442:Ceftazidime / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003320:Corneal Ulcer / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery*; D004359:Drug Therapy, Combination; D019573:Epithelium, Corneal / Q000502:physiology; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D014640:Vancomycin / Q000627:therapeutic use; D014945:Wound Healing
D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D014640:Vancomycin; D000583:Amikacin; D002442:Ceftazidime