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Amniotic Membrane Transplantation and Fibrin Glue in the Management of Corneal Ulcers and Perforations: A Review of 33 Cases

Hick, Sandrine MD*†‡; Demers, Pierre E MD, FRCSC†§; Brunette, Isabelle MD, FRCSC‡§; La, Céline MD*; Mabon, Michèle MD; Duchesne, Bernard MD*

doi: 10.1097/01.ico.0000151547.08113.d1
Clinical Sciences

Purpose: To evaluate the efficacy of amniotic membrane in corneal ulcers refractive to conventional treatment and amniotic membrane with fibrin glue in corneal perforations.

Methods: Amniotic membrane transplantation (AMT) was performed in 33 eyes from 32 patients for corneal ulcers refractive to conventional treatment. Fourteen ulcers were perforated and received fibrin glue and amniotic membrane. Ulcers were divided into 3 groups: neurotrophic or exposure, autoimmune, and other etiology.

Results: Overall success was observed in 80% (27/33 eyes) of the cases, with success rates of 87.5% (14/16 eyes), 70% (7/10 eyes), 85.7% (6/7 eyes) in groups 1, 2, and 3, respectively. The ulcers healed in a mean time of 3.6 ± 1.6 weeks and the follow-up was 14.8 ± 9.9 months. Failure was noted in 6 eyes with severe neurotrophic keratitis, Stevens-Johnson syndrome, ocular cicatricial pemphigoid, and Acanthamoeba keratitis. Grafts with fibrin sealant showed a success rate of 92.9 % (13/14 eyes) compared to 73.7% (14/19 eyes) for amniotic grafts alone. In patients with severe limbal damage, a success rate of only 20% (1/5) was observed.

Conclusions: AMT is a viable option in the treatment of nonhealing corneal ulcers of various depth and etiologies. Perforations up to 3 mm can be safely managed by fibrin glue and AMT. These techniques lead to rapid reconstruction of the corneal surface and can give a good final functional result or allow keratoplasty to be done in more favorable conditions.

From the *Department of Ophthalmology, University of Liège, Liège, Belgium; †Department of Ophthalmology, Centre Hospitalier Universitaire de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada; ‡Department of Ophthalmology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada; §Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada.

Received January 8, 2004; revision received August 26, 2004; accepted August 27, 2004.

This study was supported by the Fondation Léon-Frédéricq, University of Liège and a Mandate for Clinical Research from the Centre Hospitalier Universitaire de Liège, Liège, Belgium.

Reprints: Bernard Duchesne, MD, Department of Ophthalmology, CHU Sart-Tilman, 4000 Liège, Belgium (e-mail: b.duchesne@chu.ulg.ac.be).

© 2005 Lippincott Williams & Wilkins, Inc.