title: Ocular surface rehabilitation: Application of human amniotic membrane in high-risk penetrating keratoplasties.
abstract: BACKGROUND
  Human amniotic membrane is a versatile tool for management of ocular surface disorders. This study evaluates the effect of cryopreserved human amniotic membrane (hAM) on one-year survival of penetrating keratoplasties (PKP) in high-risk recipients.
  
  
  METHODS
  This is a retrospective noncomparative cohort study of 58 consecutive eyes undergoing PKP with concurrent placement of a self-retained cryopreserved hAM (PROKERA®) at a tertiary care center from January 2009 to July 2010.
  
  
  RESULTS
  Mean patient age was 66.7 ± 17.2 years and 30 (54%) were males. 51 eyes were pseudophakic and one aphakic. 27 eyes were glaucomatous; 24 had glaucoma drainage device and 2 had previous endocyclophotocoagulation. 12 patients had PKP for the first time and 46 had repeat PKP (average number of prior PKP = 1.63 ± 1.1, range: 1-5). Risk factors for graft failure included repeat PKP (79.3%), corneal neovascularization (51.7%), preexisting glaucoma (46.6%), and presence of anterior synechiae (37.9%). Both First Transplant and Repeat Transplant groups had similar survival rates until 6 months after transplant (75% vs 74%, odds ratio = 1.06, p = 1.00). At 12 months, First Transplant group showed a better survival rate (67% vs 43%, odds ratio = 2.60, p = 0.20). Eyes with >3 risk factors had a higher graft failure rate (odds ratio = 5.81, p = 0.003).
  
  
  CONCLUSIONS
  Survey of the literature suggests that high-risk PKP with concurrent hAM placement demonstrate comparable graft survival. Presence of multiple risk factors is associated with poor survival.
authors.affiliation: Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors.forename: Pho
authors.initials: P
authors.lastname: Nguyen
authors.affiliation: Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Rue
authors.affiliation: Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Heur
authors.affiliation: Department of Ophthalmology, The Wilmer Eye Institute, The John Hopkins University, Baltimore, MD, USA.
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Yiu
keywords: Amniotic membrane; Anti-angiogenesis; Graft rejection; Immunomodulation; Penetrating keratoplasty; ProKera