title: Combined amniotic membrane transplant and anterior stromal puncture in painful bullous keratopathy: clinical outcome and confocal microscopy.
abstract: OBJECTIVE
  To report the outcomes of anterior stromal micropuncture (ASP) combined with amniotic membrane transplantation (AMT) in the management of painful bullous keratopathy (BK) with poor visual potential, and to assess amniotic membrane (AM) retention.
  
  
  METHODS
  Case series, retrospective review.
  
  
  METHODS
  Twelve eyes of 12 patients with BK causing intractable pain or discomfort and poor visual potential, treated between March 2006 and October 2008 at Gartnavel General Hospital, Glasgow.
  
  
  METHODS
  Epithelial debridement was followed by ASP and the amniotic membrane was stabilized with a purse-string 10/0 nylon corneal suture and a bandage contact lens. During a mean follow-up of 67 weeks (range, 27-139 weeks), pain relief, epithelial healing, visual changes, confocal microscopy, and appearance of new bullae were evaluated. Success was defined as complete resolution or significant improvement in pain.
  
  
  RESULTS
  Twelve eyes of 12 patients, mean age 61 years (range, 40-88 years), were identified. Corneal epithelial healing was complete in 11 eyes 1 month postoperatively. Pain and conjunctival inflammation resolved in 11 patients (91.67%) and improved from severe to mild in the remaining patient. Incorporation of the AMT was observed on slit-lamp biomicroscopy in all eyes and was confirmed using confocal microscopy at final follow-up.
  
  
  CONCLUSIONS
  ASP combined with AMT is safe and effective, alleviates pain and discomfort, reduces ocular inflammation, and promotes epithelial healing and resolution of bullae in patients with BK with poor visual potential. There was long-term evidence of amniotic membrane graft retention in all eyes after the procedure, suggesting that ASP may improve the long-term retention rate of AM.
authors.affiliation: Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, U.K. gregoryme25@yahoo.co.uk
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Gregory
authors.forename: Kurt
authors.initials: K
authors.lastname: Spiteri-Cornish
authors.forename: Bernardine
authors.initials: B
authors.lastname: Hegarty
authors.forename: Sanjay
authors.initials: S
authors.lastname: Mantry
authors.forename: Kanna
authors.initials: K
authors.lastname: Ramaesh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000650:Amnion / Q000637:transplantation*; D001684:Biological Dressings; D003131:Combined Modality Therapy; D015715:Corneal Edema / Q000601:surgery*; D003319:Corneal Stroma / Q000473:pathology / Q000601:surgery*; D003646:Debridement; D058447:Eye Pain / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D011677:Punctures; D012189:Retrospective Studies; D016896:Treatment Outcome; D014945:Wound Healing