title: Amniotic membrane graft to conjunctival flap in treatment of non-viral resistant infectious keratitis: a randomised clinical study.
abstract: OBJECTIVE
  To evaluate and compare the results of bipedicle conjunctival flap (CF) and cryopreserved amniotic membrane graft (AMG) in the treatment of non-viral infectious keratitis resistant to medical treatment.
  
  
  METHODS
  This prospective randomised interventional study included 40 eyes of 40 patients with resistant non-viral infectious keratitis. Twenty eyes received CF and 20 eyes received AMG. In the CF group, there were 12 eyes with fungal keratitis, 7 eyes with bacterial keratitis and 1 eye with Acanthamoeba keratitis. In the AMG group there were 13 eyes with fungal keratitis, 5 eyes with bacterial keratitis and 2 eyes with Acanthamoeba keratitis. In the CF group, three ulcers had descemetocele and four ulcers were perforated. In the AMG group, four ulcers had descemetocele and two ulcers were perforated. In CF, 360° peritomy was done and a bipedicle CF from the upper conjunctiva was dissected from Tenon's capsule, mobilised to cover the cornea and sutured to episclera. In AMG, one or two layers of AM were trimmed to fit the ulcer and sutured to the cornea. The follow-up period was 6 months.
  
  
  RESULTS
  Successful results were observed in 18/20 eyes (90%) in each group. Postoperatively, no significant differences between the two groups were found regarding success rate (p=1.0), epithelialisation time (p=0.75) or visual acuity improvement (p=0.84).
  
  
  CONCLUSIONS
  CF and AMG are effective in treatment-resistant infectious keratitis. They could restore ocular surface integrity and provide metabolic and mechanical support for corneal healing. For large corneal perforation, it may be better to use another procedure such as penetrating keratoplasty to restore ocular integrity.
authors: Department of Ophthalmology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors: Bahaa-Eldin Hasan
authors: BE
authors: Abdulhalim
authors: Department of Ophthalmology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors: Mostafa Mohamed
authors: MM
authors: Wagih
authors: Department of Ophthalmology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors: Ahmed A M
authors: AA
authors: Gad
authors: Department of Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors: Ghada
authors: G
authors: Boghdadi
authors: Department of Ophthalmology, El-Minia Eye Hospital, El-Minia, Egypt.
authors: Ragy R S
authors: RR
authors: Nagy
mesh_terms: D015823:Acanthamoeba Keratitis / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D000368:Aged; D000650:Amnion / Q000637:transplantation*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D003228:Conjunctiva / Q000601:surgery*; D003315:Cornea / Q000382:microbiology / Q000469:parasitology; D003320:Corneal Ulcer / Q000175:diagnosis / Q000601:surgery*; D015925:Cryopreservation; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000601:surgery*; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013524:Surgical Flaps
chemical_list: D000900:Anti-Bacterial Agents
keywords: Cornea; Infection