Long-Term Follow-Up of Multilayer Amniotic Membrane Transplantation (MLAMT) for Non-Traumatic Corneal Perforations or Deep Ulcers with Descemetocele

Abstract

Background: To evaluate the long-term efficacy of multilayer amniotic membrane transplantation for reconstruction of epithelium and stroma in non-traumatic corneal perforations (less than 2 mm) or deep ulcers with descemetocele.

Design: Retrospective, non-comparative, interventional case series.

Patients and Methods: Eleven consecutive patients with non-traumatic corneal perforations or deep corneal ulcers with descemetocele refractory to conventional treatments: herpetic or zoster keratitis (n = 4), Sjögrenʼs syndrome (n = 2), rosacea (n = 1), hydrops (n = 1), mucous membrane pemphigoid (n = 1), bacterial keratitis (n = 1) and perforation after protontherapy for melanoma (n = 1). Intervention was: multilayer amniotic membrane transplantation with cryopreserved amniotic membrane. Complication rate and clinical outcome were evaluated in this long-term follow-up.

Results: Mean follow-up was 32 months (12 to 60). Integration of the multilayer amniotic membrane was obtained in 10 cases after one year. Corneal epithelium healed above the membrane in 10 cases within 3 weeks and remained stable after 32 months in 9 cases. Thickness of the stroma was increased and remained stable during the follow-up in 9 cases. In one case herpetic keratitis recurred with a corneal perforation. The clearing of the amniotic membrane was gradually obtained over a period of 11 months. Complications occurred in 15 % of the eyes during the long-term follow-up.

Conclusion: Multilayer amniotic membrane transplantation is a safe and efficient technique for a long restoration of the corneal integrity after non-traumatic corneal perforations or deep corneal ulcers with descemetocele. Long-term prognosis of these eyes depends of the gravity of the initial disease.

Zusammenfassung

Hintergrund: Ziel ist die Evaluation der langfristigen Wirksamkeit von Multilayer-Amnionmembran-Transplantationen für den Wiederaufbau von Epithel und Stroma in nicht traumatischen Hornhautperforationen oder tiefen Hornhautulzeras mit Descemetozele.

Design: Retrospektive, nicht vergleichbare interventionelle Fallserie.

Patienten und Methoden: Elf konsekutive Patienten mit nicht traumatischen Hornhautperforationen oder tiefen Hornhautulzeras wurden eingeschlossen: Herpeskeratitis (n = 5), Rosazea (n = 1), Sjögren-Syndrom (n = 2), Hydrops (n = 1), Schleimhautpemphigoid (n = 1), bakterieller Abszess (n = 1) und Hornhautperforation nach Protonentherapie (n = 1). Die Intervention war eine Multilayer-Amnionmembran-Transplantation mit kryokonservierter Amnionmembran.

Ergebnisse: Die mittlere Nachbeobachtungszeit betrug 32 Monaten (12 bis 60). Eine vollständige Integration der Amnionmembran in die Hornhaut wurde in 10 Fällen beobachtet. Bei 9 von 11 Patienten waren die Entzündungszeichen nach der Multilayer-Amnionmembran-Transplantation deutlich reduziert. Das Hornhautepithel über der Membran schloss sich in 9 Fällen komplett innerhalb von 3 Wochen und war nach 51 Monaten immer noch intakt. An dem Ort, an welchem sich das Ulkus befand, wurde eine Verdickung des Hornhautstromas beobachtet. Bei einem Patienten fand sich eine rezidivierende Herpeskeratitis, was zu einer Hornhautperforation führte. Die Aufklärung der Amnionmembran fand schrittweise statt, und nach 9 Monaten war die Hornhaut komplett durchsichtig.

Fazit: Die Multilayer-Amnionmembran-Transplantation ist eine sichere und effiziente Technik für eine langanhaltende Wiederherstellung der Hornhautintegrität nach nicht traumatischen Hornhautperforationen oder tiefen Hornhautulzeras mit Descemetozele.

Key words

multilayer amniotic membrane transplantation - non-traumatic corneal perforation - deep ulcer - descemetocele

Schlüsselwörter

Multilayer-Amnionmembran-Transplantation - nicht traumatische Hornhautperforation - tiefe Hornhautulzera - Descemetozele

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