gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

Amniotic membrane transplantation in severe infectious keratitis to achieve a quiet eye for elective penetrating keratoplasty

Meeting Abstract

  • corresponding author B. Seitz - Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen; website: www.kornea.org
  • K. Harrer - Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen; website: www.kornea.org
  • R. Sauer - Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen; website: www.kornea.org
  • A. Langenbucher - Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen; website: www.kornea.org
  • C. Hofmann-Rummelt - Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen; website: www.kornea.org
  • F. E. Kruse - Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen; website: www.kornea.org

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogDO.16.06

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dog2004/04dog142.shtml

Veröffentlicht: 22. September 2004

© 2004 Seitz et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Emergency keratoplasties (à chaud) in acute infectious corneal ulcers have a very limited prognosis. Amniotic membrane (AM) is known to promote epithelialization and has antiinflammatory as well as antiinfectious properties. The purpose of this study was to assess the outcome of elective penetrating keratoplasty (PK) in the quiet eye after AM transplantation (AMT) for severe in-fectious ulcerative keratitis.

Methods

7 to 41(median 20) days after onset of intensive antiinfectious medication an AMT (4 graft, 5 sandwich) was performed in 9 patients (8 male, 1 female, age 46 to 80 (median 75) years) with herpetic (n=4), bacterial keratitis (n=2), or combinations (n=3). 3 to 10 (median 4) months after cessation of the inflammatory status of the eye a central elective PK (diameter 7,0 mm, 4x single sutures) became feasible in 7 eyes. In 2 eyes a PK à chaud was necessary after 18 days resp. 3 months due to a perforated ulcer. 'AMT-Success' was defined as closed epithelium after 4 weeks. Follow-up ranged from 4 to 37 (median 20) months after PK.

Results

Primary success rate of AMT was 8/9. Four recurrences were treated successfully 3x by repeat AMT (sandwich) and 1x by PK à chaud. In 1/7 an irreversible endothelial graft reaction led to repeat PK 15 months after elective PK. No eye suffered from recurrence of herpetic keratitis on the corneal graft. At the end of follow-up 8 of 9 (all 7 elective) grafts were clear. Mean endothelial cell count was 1564±622 cells/mm2. Median best-corrected visual acuity increased from HM before AMT and HM before PK to 0.2 (maximum 0.5; 2x advanced glaucomatous disc cupping) at the end of follow-up.

Conclusions

A rapid decrease of inflammatory reaction and a fast reepithelialization of AMT after intensive antiinfectious medication in case of severe ulcerative keratitis may help to avoid an emergency keratoplasty (à chaud) in most cases. An elective subsequent PK in the quiet eye seems to have a much more favorable prognosis.