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Amniotic membrane transplantation for persistent corneal ulcers and perforations in acute fungal keratitis.
Cornea 2006; 25(5):564-72C

Abstract

PURPOSE

To report the therapeutic effect and complications of amniotic membrane transplantation (AMT) in acute fungal keratitis.

METHODS

Diagnosis of fungal keratitis was confirmed by cultures in 23 eyes of 23 patients. The indications to perform AMT were to promote reepithelialization in non-healing ulcers or to prevent corneal perforation. Antifungal agents were administered throughout the whole course of hospitalization. Repeated cultures were performed immediately before AMT. The main outcome measurements were epithelial healing rate, necessity of therapeutic penetrating keratoplasty (TPK), and persistence of infection.

RESULTS

During a mean follow-up time of 20.6 months +/- 23.22 (6-65 months) AMT was performed during the active phase of the keratitis (fungal culture was still positive) in 16 patients (69.6%), and during the inactive phase (fungal culture negative) in 7 patients (30.4%). Single-layer AMT was performed in 17 patients, and double-layer AMT was performed in 6 patients with corneal perforation and anterior chamber collapse. Complete epithelialization was observed in 12 patients (75%) in the active group and in 7 patients (100%) in the inactive group. Treatment failure requiring TPK was experienced in 4 patients (25%) in the active group. Persistent fungal keratitis was noted in 2 patients (8.7%) in that group. The final visual acuity improved in 17 cases, worsened in 2 cases, and remained unchanged in 4 cases. Twelve of the 23 eyes (52.2%) in this study preserved useful vision (20/400 and better) with or without subsequent surgeries.

CONCLUSION

AMT is effective in promoting epithelialization and preventing corneal perforations in acute fungal keratitis, and there is no risk of rejection. However, the risk of persistent or recurrent infection necessitates continued antifungal treatment and patient monitoring.

Authors+Show Affiliations

Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

16783145

Citation

Chen, Hung-Chi, et al. "Amniotic Membrane Transplantation for Persistent Corneal Ulcers and Perforations in Acute Fungal Keratitis." Cornea, vol. 25, no. 5, 2006, pp. 564-72.
Chen HC, Tan HY, Hsiao CH, et al. Amniotic membrane transplantation for persistent corneal ulcers and perforations in acute fungal keratitis. Cornea. 2006;25(5):564-72.
Chen, H. C., Tan, H. Y., Hsiao, C. H., Huang, S. C., Lin, K. K., & Ma, D. H. (2006). Amniotic membrane transplantation for persistent corneal ulcers and perforations in acute fungal keratitis. Cornea, 25(5), pp. 564-72.
Chen HC, et al. Amniotic Membrane Transplantation for Persistent Corneal Ulcers and Perforations in Acute Fungal Keratitis. Cornea. 2006;25(5):564-72. PubMed PMID: 16783145.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Amniotic membrane transplantation for persistent corneal ulcers and perforations in acute fungal keratitis. AU - Chen,Hung-Chi, AU - Tan,Hsin-Yuan, AU - Hsiao,Ching-Hsi, AU - Huang,Samuel Chao-Ming, AU - Lin,Ken-Kuo, AU - Ma,David Hui-Kang, PY - 2006/6/20/pubmed PY - 2006/8/4/medline PY - 2006/6/20/entrez SP - 564 EP - 72 JF - Cornea JO - Cornea VL - 25 IS - 5 N2 - PURPOSE: To report the therapeutic effect and complications of amniotic membrane transplantation (AMT) in acute fungal keratitis. METHODS: Diagnosis of fungal keratitis was confirmed by cultures in 23 eyes of 23 patients. The indications to perform AMT were to promote reepithelialization in non-healing ulcers or to prevent corneal perforation. Antifungal agents were administered throughout the whole course of hospitalization. Repeated cultures were performed immediately before AMT. The main outcome measurements were epithelial healing rate, necessity of therapeutic penetrating keratoplasty (TPK), and persistence of infection. RESULTS: During a mean follow-up time of 20.6 months +/- 23.22 (6-65 months) AMT was performed during the active phase of the keratitis (fungal culture was still positive) in 16 patients (69.6%), and during the inactive phase (fungal culture negative) in 7 patients (30.4%). Single-layer AMT was performed in 17 patients, and double-layer AMT was performed in 6 patients with corneal perforation and anterior chamber collapse. Complete epithelialization was observed in 12 patients (75%) in the active group and in 7 patients (100%) in the inactive group. Treatment failure requiring TPK was experienced in 4 patients (25%) in the active group. Persistent fungal keratitis was noted in 2 patients (8.7%) in that group. The final visual acuity improved in 17 cases, worsened in 2 cases, and remained unchanged in 4 cases. Twelve of the 23 eyes (52.2%) in this study preserved useful vision (20/400 and better) with or without subsequent surgeries. CONCLUSION: AMT is effective in promoting epithelialization and preventing corneal perforations in acute fungal keratitis, and there is no risk of rejection. However, the risk of persistent or recurrent infection necessitates continued antifungal treatment and patient monitoring. SN - 0277-3740 UR - https://www.unboundmedicine.com/medline/citation/16783145/Amniotic_membrane_transplantation_for_persistent_corneal_ulcers_and_perforations_in_acute_fungal_keratitis_ L2 - http://Insights.ovid.com/pubmed?pmid=16783145 DB - PRIME DP - Unbound Medicine ER -