title: Prospective comparison of two suturing techniques of amniotic membrane transplantation for symptomatic bullous keratopathy.
abstract: OBJECTIVE
  To determine the outcomes of a modified amniotic membrane transplantation (AMT) suturing technique for pain and discomfort relief in patients with symptomatic bullous keratopathy (BK).
  
  
  METHODS
  Randomized, double-blind controlled clinical trial.
  
  
  METHODS
  setting: Ankara Research and Training Hospital 1st and 2nd Eye Clinics, Ankara, Turkey. study population: This prospective study included 39 eyes (39 patients) with BK presenting with intractable pain or discomfort and poor visual potential. intervention: Patients were randomly assigned into two groups: in group 1 (21 patients), patients underwent a modified AMT suturing technique; a groove was prepared by vacuum trephine on the recipient cornea and the edges of the punch-shaped amniotic membrane (AM) were sutured to this groove with the basement membrane side up. In group 2 (18 patients), patients underwent the standard AMT suturing to the cornea. main outcome measure: During a mean follow-up of 27.3 +/- 8.5 months (standard deviation) (range, 12 to 36 months), epithelial healing, persistence of AM, pain relief, and visual changes were analyzed and were compared between groups.
  
  
  RESULTS
  The mean age (P = .15), the mean follow-up (P = .73), and the mean preoperative visual acuity (P = .53) were similar in both groups. With the modified suturing technique, the postoperative visual acuity was better (P = .03), epithelialization time was shorter (P < .001), and the AM remained longer (P < .001). Successful epithelialization was achieved in 20 eyes (95.3%) in group 1, and in 16 eyes (88.9%) in group 2 (P = .586). The pain scores of patients in group 1 remained stable (P = .223) over time, however increased from the first week to the third month postoperatively in group 2 (P = .046).
  
  
  CONCLUSIONS
  The modified AMT suturing technique has a similar epithelialization rate to standard AMT suturing to cornea. Though technically more demanding, shorter epithelialization time, longer persistence of AM, and stable pain scores in the postoperative period makes this a promising method for the treatment of symptomatic BK.
authors.affiliation: Department of Ophthalmology Ankara Research and Training Hospital, Ankara, Turkey. ealtiparmak@hotmail.com
authors.forename: Ugur E
authors.initials: UE
authors.lastname: Altiparmak
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Oflu
authors.forename: Elvin H
authors.initials: EH
authors.lastname: Yildiz
authors.forename: Koray
authors.initials: K
authors.lastname: Budak
authors.forename: Bekir Sitki
authors.initials: BS
authors.lastname: Aslan
authors.forename: Ayse
authors.initials: A
authors.lastname: Nurozler
authors.forename: Mustafa
authors.initials: M
authors.lastname: Onat
authors.forename: Remzi
authors.initials: R
authors.lastname: Kasim
authors.forename: Sunay
authors.initials: S
authors.lastname: Duman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000650:Amnion / Q000637:transplantation*; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D004311:Double-Blind Method; D019573:Epithelium, Corneal / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010166:Palliative Care; D011446:Prospective Studies; D013536:Suture Techniques; D014792:Visual Acuity / Q000502:physiology; D014945:Wound Healing