title: Multilayer amniotic membrane transplantation for bacterial keratitis with corneal perforation after hyperopic photorefractive keratectomy: case report and literature review.
abstract: We report a case of corneal infection caused by Streptococcus pneumoniae after hyperopic photorefractive keratectomy (PRK) that produced severe corneal melting, ulceration, and multiple perforations. Treatment included antibiogram-based antibiotic topical therapy and multilayer amniotic membrane transplantation (AMT) performed to seal the perforations and restore the globe integrity. Clinical and anterior segment optical coherence tomography (Visante OCT, Carl Zeiss Meditec) examinations documented progressive integration of the amniotic membrane tissues within the cornea, stromal and epithelial healing, and recovery of a stable and regular anterior chamber. The cornea healed with an avascular leucoma; the best corrected visual acuity was reduced to 20/200. Severe pneumococcal ulcerative perforation is a potential complication of PRK. Penetrating keratoplasty, at high risk for failure in the acute settings of an infected and inflamed eye, can be delayed until the cornea is healed. Amniotic membrane transplantation may be an alternative surgical option to achieve this goal.
authors.affiliation: Department of Medicine and Aging Science, Ophthalmic Clinic, University of Chieti-Pescara, Italy. m.nubile@unich.it
authors.forename: Mario
authors.initials: M
authors.lastname: Nubile
authors.forename: Paolo
authors.initials: P
authors.lastname: Carpineto
authors.forename: Manuela
authors.initials: M
authors.lastname: Lanzini
authors.forename: Marco
authors.initials: M
authors.lastname: Ciancaglini
authors.forename: Eduardo
authors.initials: E
authors.lastname: Zuppardi
authors.forename: Leonardo
authors.initials: L
authors.lastname: Mastropasqua
mesh_terms: D000650:Amnion / Q000637:transplantation*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003320:Corneal Ulcer / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D006956:Hyperopia / Q000601:surgery*; D054018:Lasers, Excimer; D008297:Male; D008875:Middle Aged; D018903:Photorefractive Keratectomy; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications; D012422:Rupture, Spontaneous; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D014945:Wound Healing
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins