Corneal Descemetocele Management with Multi-Layer Amniotic Membrane Transplantation in an Ocular Graft-versus-Host Disease Case

Abstract

Background: Chronic ocular graft-versus-host disease (oGVHD) is a common ocular complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT), characterized by progressive inflammation of the ocular surface and refractory dry eye. In severe cases, sterile corneal perforation can occur, which poses a significant challenge, due to the low survival rate of grafts after corneal transplantation. Case Presentation: A 47-year-old female presented to our hospital with persistent dryness, foreign body sensation, and blurred vision in her left eye. Diagnosis of graft-versus-host disease with corneal descemetocele in the left eye was made after detailed history review and thorough examination. Multi-layer amniotic membrane transplantation was performed in the affected eye, resulting in amelioration of the patient's symptoms. This amelioration of symptoms provided the patient with a level of comfort that permitted additional time while awaiting corneal transplantation. Conclusions: We report a successful case of multi-layer amniotic membrane transplantation for the management of corneal descemetocele following allo-HSCT.

Keywords: amniotic membrane transplantation; case report; corneal descemetocele; ocular graft-versus-host disease (oGVHD); sterile corneal melting.

Figure 1

Preoperative anterior segment photography of right eye (A) appearing within normal limits and left eye (C) with corneal descemetocele (arrow) in the inferior central cornea within an oval cloudy stromal ulcer. Anterior segment optical coherence tomography (AS-OCT) of right eye (B) and left eye (D) with evidence of corneal thinning (arrow) consistent with the descemetocele observed in (C).

Figure 2

Intraoperative anterior segment photographs of the surgical procedure of multilayer amniotic membrane transplantation. (A) following debridement of the corneal ulcer; (B) the folded multilayered amniotic membrane positioned in the bed of the corneal ulcer; (C) a single layer of amniotic membrane covering the multi-layered amniotic membrane; and (D) following suturing with 10–0 nylon.

Figure 3

Anterior segment photography of the left eye right after the surgery (A). Intraoperative OCT after multilayer amniotic transplantation. Corneal thickness was restored to a more or less normal corneal thickness at the end of the operation, as presented in horizontal (B) and vertical (C) OCT scans.

Figure 4

Anterior segment photography of the left eye three months after the surgery (A) and AS-OCT (B) demonstrating amniotic membrane integrated into the cornea with restoration of a more or less normal corneal thickness.