gms | German Medical Science

The combined use of amniotic membrane and fibrin glue was proposed to be a suitable method for the treatment of corneal perforation. However, the immediate coagulation of both of the fibrin components does not allow any further corrective manipulation of the membrane. We present a modified microsurgical procedure to overcome this difficulty.

Surgical procedure: 1. Regular debridement and removal of circumferential epithelium, 2. temporary placement of amniotic membrane on normal bulbar conjunctiva, 3. application of fibrinogen to the ulcer surface, 4. application of a small amount of thrombine to an intact part of the neighbouring cornea, 5. rotary movement of the amniotic membrane, first over the thrombine component and then to the ulcer as a graft (step 2-5 might be repeated with several membranes), 6. application and suture of an overlying amniotic membrane.

Three patients suffering from monolateral corneal perforation were treated with 1 to 5 fibrin sealed amniotic membrane grafts. Difficulties in placing membranes even in complex ulcer configuration were not observed.

This application method allows to treat corneal perforation with multiple amniotic membrane grafts and avoids mechanical problems due to the immediate coagulation of fibrin sealant.