Amniotic membrane graft for the management of scleral melting and corneal perforation in recalcitrant infectious scleral and corneoscleral ulcers

Cornea
David Hui-Kang MaRay Jui-Fang Tsai

Abstract

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. 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. 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...Continue Reading

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