title: Use of a hyperdried cross-linked amniotic membrane as initial therapy for corneal perforations.
abstract: OBJECTIVE
  To report the use of hyperdried cross-linked (HDCL) amniotic membrane (AM) patching with tissue adhesive as an initial therapy for corneal perforations.
  
  
  METHODS
  Cryopreserved AM was cross-linked with 0.1% glutaraldehyde and then dried using far-infrared rays and microwaves (hyperdry method). Three eyes of three patients with corneal perforations of up to 3 mm in diameter were included in this study. They were treated with a single-layer patch of HDCL-AM applied with a tissue adhesive (2-octyl-cyanoacrylate). We also evaluated the resistance of HDCL-AM to collagenases during in vitro digestion testing.
  
  
  RESULTS
  In all three cases, the corneal perforations were repaired within 28 days (range, 17-28 days). No recurrence occurred during the follow-up period (3-6 months). In the collagenase digestion testing, the HDCL-AM did not dissolve until 48 h, whereas the cryopreserved AM completely dissolved within 60 min.
  
  
  CONCLUSIONS
  Three cases of corneal perforations were successfully managed using HDCL-AM patching with tissue adhesive. The HDCL-AM was resistant to collagenases during in vitro digestion testing. The HDCL-AM was a useful substrate for corneal perforations. This simple surgical technique may be one of the initial therapeutic options for corneal perforations.
authors.affiliation: Department of Ophthalmology, University of Toyama, Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Kitagawa
authors.forename: Motonori
authors.initials: M
authors.lastname: Okabe
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Yanagisawa
authors.forename: Xue-Yun
authors.initials: XY
authors.lastname: Zhang
authors.forename: Toshio
authors.initials: T
authors.lastname: Nikaido
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hayashi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000650:Amnion / Q000737:chemistry / Q000187:drug effects*; D001684:Biological Dressings; D017364:Collagenases / Q000494:pharmacology; D057112:Corneal Perforation / Q000628:therapy*; D003432:Cross-Linking Reagents / Q000494:pharmacology*; D003487:Cyanoacrylates / Q000627:therapeutic use; D003890:Desiccation; D005260:Female; D005976:Glutaral / Q000494:pharmacology; D006801:Humans; D008297:Male; D013997:Time Factors; D014014:Tissue Adhesives / Q000627:therapeutic use; D014945:Wound Healing
chemical_list: D003432:Cross-Linking Reagents; D003487:Cyanoacrylates; D014014:Tissue Adhesives; C100832:octyl 2-cyanoacrylate; D017364:Collagenases; D005976:Glutaral