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Amniotic Membrane Graft for the Management of Scleral Melting and Corneal Perforation in Recalcitrant Infectious Scleral and Corneoscleral Ulcers

Ma, David Hui-Kang M.D., Ph.D.; Wang, Su-Fang M.D.; Su, Wan-Ya M.D.; Tsai, Ray Jui-Fang M.D.

Clinical Sciences

Purpose. To study the efficacy and safety of using cryopreserved human amniotic membrane (AM) graft as a patch graft to reduce stromal melting and promote reepithelialization in extensive infectious scleral and corneoscleral ulcers.

Methods. Four cases of infectious scleral ulcers with persistent scleral melting and no sign of reepithelialization and three cases of corneoscleral ulcers with corneal perforation were studied. All patients had previously undergone pterygium excision, and infections were caused by Pseudomonas (n = 4), fungi (n = 2), and atypical Mycobacterium (n = 1). The area of limbus involved ranged from 3 to 9 (mean, 4.7) o'clock positions. Repeated debridements were performed, the causative microorganisms were identified, and the appropriate topical and systemic antibiotics were given to all patients before AM grafting. Postoperatively, the speed of reepithelialization, changes in the severity of scleral melting and inflammation, recurrence of infection, and visual acuity were documented.

Results. Melting and inflammation at the lesion site decreased after AM grafting. Reepithelialization of the scleral lesions was complete at an average 15.7 ± 8.7 days (range, 5–31) postoperatively. Focal melting of the AM graft occurred in two cases, and in one case, it was necessary to perform further corneoscleral graft. No recurrent infection was encountered, but sterile abscess occurred in three cases that were located away from the original lesion. Useful vision above 20/400 was maintained in all patients at the end of follow-up.

Conclusion. The AM graft is effective in promoting conjunctival reepithelialization and reducing scleral melting and inflammation and can be considered as an alternative biomaterial to improve wound healing in scleral and corneoscleral ulcerations.

From the Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan (D.H.-K.M., W.-Y.S., R.J.-F.T.); Department of Radiology, Taipei Veterans General Hospital and Medical School of National Yang-Ming University, Taipei (S.-F.W.), Taiwan.

Submitted July 12, 2001.

Revision received January 15, 2002.

Accepted January 20, 2002.

The authors have no financial interest in the clinical usage of amniotic membrane.

Address correspondence and reprint requests to Ray Jui-Fang Tsai, M.D., 2F 350 Section 4, Cheng Kung Road, Taipei, Taiwan 114. E-mail:

© 2002 Lippincott Williams & Wilkins, Inc.