ABSTRACT

Purpose:

To evaluate the effect of amniotic membrane transplantation (AMT) in the treatment of corneal ulcers resulting from herpetic keratitis (HK) and bacterial keratitis (BK).

Material and Method:

Forty-six patients (25 HK, 21 BK) treated with AMT for HK or BK-related corneal ulcers between January 2009 and September 2011 were followed prospectively. The visual acuities and ulcer characteristics (depth and localization) prior to AMT and epithelialization time, as well as final visual acuities after AMT, were evaluated.

Results:

The mean age was 51.9±17.0 years in HK and 53.3±22.0 years in BK and the mean follow-up time was 12.6±6.1 (5-33) months and 10.2±6.8 (3-27) months, respectively. The ulcers were mostly central in HK (72%) and paracentral in BK (52.4%) (p=0.03). Ulcer depth was deeper than 1/2 of the cornea in 14 (56%) HK and in 7 (33.3%) BK (p=0.290). Eight HK patients had scars from previous herpetic keratitis episodes. The mean epithelialization time was 22.3±8.5 (12-50) days in HK and 22.1±10.9 (8-45) days in BK (p=0.488). While epithelialization was achieved in all the patients with BK, 3 HK patients needed adjunctive surgeries (conjunctival flap, tectonic penetrating keratoplasty) in spite of three AMTs. Although visual acuities improved significantly in both groups, this improvement was more evident in BK cases (p=0.018 for HK and p<0.001 for BK).

Discussion:

Amniotic membrane transplantation is an effective and safe treatment for bacterial and herpetic corneal ulcers. The reason for the lower final visual acuities in the herpetic group was thought to be related to a more central location, deeper involvement and scars due to previous attacks.