Amniotic membrane transplantation for wound dehiscence after deep lamellar keratoplasty: a case report
© Kawakita et al; licensee BioMed Central Ltd. 2007
Received: 18 March 2007
Accepted: 13 June 2007
Published: 13 June 2007
To report amniotic membrane (AM) transplantation in a patient with wound dehiscence 5 months after deep lamellar keratoplasty (DLKP)
The patient was an 84-year-old Japanese man who had undergone right DLKP 5 months earlier for central corneal scarring due to recurrent stromal herpetic keratitis. He developed wound dehiscence with corneal stromal melting due to recurrence of stromal herpes in both the donor and recipient sites. "AM roll-in filling technique" and AM patching were performed.
Following AM transplantation, stromal inflammation subsided and complete epithelization occurred within 10 days of surgery.
At 8 months postoperatively, biomicroscopy revealed stable wound apposition or stromal gain. Following AM transplantation, stromal inflammation subsided and complete epithelialization was achieved within 10 days after surgery.
AM transplantation may offer an effective treatment modality for herpetic corneal wound dehiscence after DLKP.
AM transplantation has been reported to be an effective ocular surface reconstruction procedure in the treatment of corneal erosions, central or peripheral ulcers and perforations, as such membranes can decrease inflammation, promote corneal epithelialization and provide corneal stromal substrate.[1, 2] We report AM transplantation in a patient with wound dehiscence 5 months after deep lamellar keratoplasty (DLKP).
DLKP with single running 10-0 nylon sutures was performed (Figure 1, right). Complete graph epithelization was achieved within 5 days. In addition to 0.1% topical dexamethasone qid (Sanbethasone®, Santen) and levofuroxacine eyedrops qid (Cravit®, Santen) for 5 months, the patient was prescribed 1000 mg/day oral acyclovir (Zovirax®, Glaxo Smith Kline), to be commenced the day prior to the operation and continued for 10 days to prevent herpetic recurrence.
Postkeratoplasty oral acyclovir prophylaxis has been reported to prevent recurrences. In our opinion, the wound perforation seen here was a result of insufficient prophylaxis with recurrence. AM transplantation has been widely reported to be an efficient procedure for central and peripheral corneal erosion, ulceration and perforations. The beneficial effectsof this approach result from the presence of a rich extracellular matrix and collagen which provide a stromal substrate as in our case and anti-inflammatory properties arising from entrapment of inflammatory cells, the presence of various growth factors, inhibition of proteinase activity, and decrease of lipid peroxidation. AM patch has also been reported to be effective in acute ulcerative and necrotizing herpetic stromal keratitis due toreduction of gelatinolytic activity of MMP-9 and increased expression of TIMP-1. These properties may have been responsible for the effective suppression of herpetic inflammation seen in this particular case.
AM has been commomly used to repair areas of corneal stromal loss by mutilayered AM, but which technique is difficult to apply for wound dehiscence because of shape of stromal loss. Our modified "AM roll-in filling technique" can provide compact and dense spacer for such stromal loss site. We have reported the successful application of AM in wound dehiscence and herpetic stromal melting after DLKP. We have also demonstrated the usefulness of the "AM roll-in filling technique" for such patients. Due to availability of corneal donor, this technique could be used as a first choice in such situation.
amniotic membrane transplantation
the best corrected visual acuities
deep lamellar keratoplasty
tissue inhibitor of metalloproteinase
The authors have no proprietary interests in any of the products mentioned in this paper. Presented at the 2005 Chiba Ophthalmologists Consultation Meeting, September 2005, Chiba, Japan. Written patient consent was received for the manuscript tobe published.
- Kim JC, Tseng SC: Transplantation of preserved human amniotic membrane for surface reconstruction in severely damaged rabbit corneas. Cornea. 1995, 14: 473-84. 10.1097/00003226-199509000-00006.View ArticlePubMedGoogle Scholar
- Hanada K, Shimazaki J, Shimmura S, Tsubota K: Multilayered amniotic membrane trans p9–85. lantation for severe ulceration of the cornea and sclera. 2001, 131: 324-331.Google Scholar
- Shimmura S, Shimazaki J, Ohashi Y, Tsubota K: Antiinflammatory effects of amniotic membrane transplantation in ocular surface disorders. Cornea. 2001, 20: 408-13. 10.1097/00003226-200105000-00015.View ArticlePubMedGoogle Scholar
- Heiligenhaus A, Li H, Hernandez Galindo EE, Koch JM, Steuhl KP, Meller D: Management of acute ulcerative and necrotising herpes simplex and zoster keratitis with amniotic membrane transplantation. Br J Ophthalmol. 2003, 87: 1215-19. 10.1136/bjo.87.10.1215.View ArticlePubMedPubMed CentralGoogle Scholar
- Heiligenhaus A, Li HF, Yang Y, WAsmuth S, Steuhl KP, Bauer D: Transplantation of amniotic membrane in murine herpes stromal keratitis modulates matrix metalloproteinases in the cornea. Invest Ophthalmol Vis Sci. 2005, 46: 407-10.1167/iovs.05-0192.View ArticleGoogle Scholar
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