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. 2024 Mar 4;87(2):e20220341.
doi: 10.5935/0004-2749.2023-2022-0341. eCollection 2024.

Amniotic membrane transplantation for neurotrophic corneal ulcers

Anna Carolina Badotti Linhares  1 , Ana Caroline Martinelli  1 , Mariela Regina Dalmarco Ghem  1 , Paula Basso Dias  1 , Daniel Wasilewski  1
Affiliations

Amniotic membrane transplantation for neurotrophic corneal ulcers

Anna Carolina Badotti Linhares et al. Arq Bras Oftalmol. .

Abstract

Purpose: To evaluate the clinical results of cryopreserved amniotic membrane transplantation as a treatment option for refractory neurotrophic corneal ulcers.

Methods: This prospective study included 11 eyes of 11 patients who underwent amniotic membrane transplantation for the treatment of refractory neurotrophic corneal ulcers at Hospital de Clínicas da Universidade Federal do Paraná, in the city of Curitiba, from May 2015 to July 2021. Patients underwent different surgical techniques in which the amniotic membrane was applied with the epithelium facing upward to promote corneal re-epithelialization.

Results: The median age of the patients was 60 years (range, 34-82 years), and 64% were men. The predominant etiology of corneal ulcers was herpes zoster (45% of cases). Approximately one-third of the patients (27%) were chronically using hypotensive eye drops, and more than half (54%) had previously undergone penetrating corneal transplantation. At the time of amniotic membrane transplantation, 18% of the eyes had corneal melting, 9% had corneal perforation, and the others had corneal ulceration without other associated complications (73%). The time between clinical diagnosis and surgical treatment ranged from 9 days to 2 years. The corrected visual acuity was worse than 20/400 in 90% of the patients preoperatively, with improvement in 36% after 3 months of the procedure, worsening in 18% and remaining stable in 36%. Of the patients, 81% complained of preoperative pain, and 66% of them reported total symptom relief after the surgical procedure. In one month, 54.6% of the patients presented a closure of epithelial defect, and half of the total group evolved with corneal thinning. The failure rate was 45.5% of the cases.

Conclusion: Cryopreserved amniotic membrane transplantation can be considered a good alternative for treating refractory neurotrophic corneal ulcers, as it resulted in significant improvement in pain (66%) and complete epithelial closure (60%) in many patients at 1 month postoperatively. Notably, the high failure rate highlights the need for further studies to identify patientand ulcer-related factors that may influence the outcomes of this procedure.

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Conflict of interest statement

Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Preoperative and immediate postoperative AM transplantation in a neurotrophic ulcer secondary to ocular herpes zoster. A. Preoperative neurotrophic ulcer, indicated by the white arrow, secondary to ocular herpes zoster. B. Immediate postoperative AM transplantation; the asterisk shows the edges of the AM that can be seen in the image, and the black arrow indicates the continuous suture near the limbus.
Figure 2
Figure 2
Time of evolution and ulcer size until AM transplantation.
Figure 3
Figure 3
Postoperative complications.
See this image and copyright information in PMC

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