title: Rate of epithelialisation and re-operations in corneal ulcers treated with amniotic membrane transplantation combined with botulinum toxin-induced ptosis.
abstract: OBJECTIVE
  To examine the efficacy of amniotic membrane transplantation (AMT) and/or botulinum toxin type A-induced ptosis (Dysport) in the treatment of corneal ulcerations of different entities.
  
  
  METHODS
  Retrospective evaluation of 137 cases of corneal ulcers which have been treated with AMT, botulinum toxin type A and perforating keratoplasty (pKP). Regarding corneal ulcerations the patients were divided into three groups: group A, patients initially having received an AMT (92 eyes eventually followed by AMT or pKP as a second intervention); group B, patients initially having received an AMT (32 eyes followed by botulinum toxin type A injection in the upper lid as a second intervention); group C, patients initially treated only by botulinum toxin type A injection (13 eyes followed occasionally by AMT or pKP or additional botulinum toxin type A injection). Additionally, we analysed the complete epithelialisation rate of the ocular surface in respect to different ocular and systemic diseases and compared the frequency of re-operations in each group.
  
  
  RESULTS
  The overall follow-up was 14.2 (+/-14.7 months; range from 1 to 60 months). The total frequency of re-operations was 45.3% (overall time until complete epithelialisation 12.7 (+/-6.1) days). If the patient was initially treated with an AMT (group A), the re-operation rate was 44.6%. Treating affected eyes in this group with a subsequent amniotic membrane resulted in a reduction of re-operation rate to 30.4%. In cases with induced ptosis by injecting botulinum toxin type A in the M. levator palpebrae (group B), the re-operation frequency could be reduced to 34.4% with similar times of epithelialisation [group A: 12.0 (+/-6.5) days and group B: 11.7 (+/-5.5) days]. In group C, with botulinum toxin type A alone initially, the re-operation rate of 69.2% was the highest one compared with groups A and B; this rate could be drastically reduced by a following AMT to 23.1%. Surprisingly, in the few successful cases with botulinum toxin type A alone a quite low epithelialisation time of 6.5 (+/-1.3) days was achieved, but turned out to be similar after additional interventions if compared with the other groups (botulinum toxin type A + AMT: 15.7 (+/-4.9) day).
  
  
  CONCLUSIONS
  AMT alone and combined with botulinum toxin type A-induced ptosis is an effective surgical approach for managing severe corneal ulcerations by promoting wound healing and stabilizing ocular surface homeostasis.
authors.affiliation: Department of Ophthalmology, University of Duisburg-Essen, 45122 Essen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fuchsluger
authors.forename: Emre
authors.initials: E
authors.lastname: Tuerkeli
authors.forename: Henrike
authors.initials: H
authors.lastname: Westekemper
authors.forename: Joachim
authors.initials: J
authors.lastname: Esser
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Steuhl
authors.forename: Daniel
authors.initials: D
authors.lastname: Meller
mesh_terms: D000650:Amnion / Q000637:transplantation*; D001763:Blepharoptosis / Q000139:chemically induced / Q000503:physiopathology*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D003320:Corneal Ulcer / Q000503:physiopathology / Q000601:surgery*; D019573:Epithelium, Corneal / Q000502:physiology*; D005143:Eyelids / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D012086:Reoperation; D012189:Retrospective Studies
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A