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Amniotic membrane transplantation combined with antiviral and steroid therapy for herpes necrotizing stromal keratitis.
Ophthalmology 2007; 114(8):1476-81O

Abstract

PURPOSE

To evaluate therapeutic effect of multilayer amniotic membrane transplantation (AMT) in conjunction with antiviral and corticosteroid therapy on herpes necrotizing stromal keratitis.

DESIGN

Retrospective interventional case series.

PARTICIPANTS

Fifteen patients (15 eyes) with herpes necrotizing stromal keratitis, persistent corneal inflammation, and impending ulcer, despite topical and systemic antiviral treatment for over 2 weeks.

METHODS

Multilayer AMT was performed in the 15 eyes. Antiviral medications and appropriate corticosteroids were administered after surgery. Remodeling of amniotic membrane (AM) and growth of epithelial cells were detected by confocal microscopy.

MAIN OUTCOME MEASURES

Visual acuity and corneal status (ulceration, edema, and opacification).

RESULTS

Follow-up ranged from 7 to 13 months (mean +/- standard deviation, 8.9+/-1.8). Visual acuity improved by > or =2 lines in 14 eyes. Central corneal ulcers healed completely at 2.0+/-0.6 weeks, and paracentral ulcers at 2.1+/-0.6 weeks (t = 0.314, P = 0.759). Corneal stromal thickness was restored in eyes with central ulcers at 2.4+/-1.2 weeks and in those with paracentral ulcers at 2.6+/-0.7 weeks (t = 0.425, P = 0.678). Superficial epithelial cells, together with small basal epithelial cells, gradually migrated to the surface of AM on postoperative weeks 1 to 3. There were corneal nebulae in 11 eyes, corneal maculae in 3 eyes, and a corneal leukoma in 1 eye at the end of follow-up. No recrudescence occurred in any eye.

CONCLUSION

Multilayer AMT combined with antiviral and corticosteroid therapy appears effective in treating herpes necrotizing stromal keratitis. It provides patients with marked scars and visual impairment an opportunity for subsequent keratoplasty by arresting the inflammatory response and reducing the graft bed diameter.

Authors+Show Affiliations

State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China.No affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17363059

Citation

Shi, Weiyun, et al. "Amniotic Membrane Transplantation Combined With Antiviral and Steroid Therapy for Herpes Necrotizing Stromal Keratitis." Ophthalmology, vol. 114, no. 8, 2007, pp. 1476-81.
Shi W, Chen M, Xie L. Amniotic membrane transplantation combined with antiviral and steroid therapy for herpes necrotizing stromal keratitis. Ophthalmology. 2007;114(8):1476-81.
Shi, W., Chen, M., & Xie, L. (2007). Amniotic membrane transplantation combined with antiviral and steroid therapy for herpes necrotizing stromal keratitis. Ophthalmology, 114(8), pp. 1476-81.
Shi W, Chen M, Xie L. Amniotic Membrane Transplantation Combined With Antiviral and Steroid Therapy for Herpes Necrotizing Stromal Keratitis. Ophthalmology. 2007;114(8):1476-81. PubMed PMID: 17363059.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Amniotic membrane transplantation combined with antiviral and steroid therapy for herpes necrotizing stromal keratitis. AU - Shi,Weiyun, AU - Chen,Min, AU - Xie,Lixin, Y1 - 2007/03/23/ PY - 2006/07/13/received PY - 2006/11/22/revised PY - 2006/11/22/accepted PY - 2007/3/17/pubmed PY - 2007/8/19/medline PY - 2007/3/17/entrez SP - 1476 EP - 81 JF - Ophthalmology JO - Ophthalmology VL - 114 IS - 8 N2 - PURPOSE: To evaluate therapeutic effect of multilayer amniotic membrane transplantation (AMT) in conjunction with antiviral and corticosteroid therapy on herpes necrotizing stromal keratitis. DESIGN: Retrospective interventional case series. PARTICIPANTS: Fifteen patients (15 eyes) with herpes necrotizing stromal keratitis, persistent corneal inflammation, and impending ulcer, despite topical and systemic antiviral treatment for over 2 weeks. METHODS: Multilayer AMT was performed in the 15 eyes. Antiviral medications and appropriate corticosteroids were administered after surgery. Remodeling of amniotic membrane (AM) and growth of epithelial cells were detected by confocal microscopy. MAIN OUTCOME MEASURES: Visual acuity and corneal status (ulceration, edema, and opacification). RESULTS: Follow-up ranged from 7 to 13 months (mean +/- standard deviation, 8.9+/-1.8). Visual acuity improved by > or =2 lines in 14 eyes. Central corneal ulcers healed completely at 2.0+/-0.6 weeks, and paracentral ulcers at 2.1+/-0.6 weeks (t = 0.314, P = 0.759). Corneal stromal thickness was restored in eyes with central ulcers at 2.4+/-1.2 weeks and in those with paracentral ulcers at 2.6+/-0.7 weeks (t = 0.425, P = 0.678). Superficial epithelial cells, together with small basal epithelial cells, gradually migrated to the surface of AM on postoperative weeks 1 to 3. There were corneal nebulae in 11 eyes, corneal maculae in 3 eyes, and a corneal leukoma in 1 eye at the end of follow-up. No recrudescence occurred in any eye. CONCLUSION: Multilayer AMT combined with antiviral and corticosteroid therapy appears effective in treating herpes necrotizing stromal keratitis. It provides patients with marked scars and visual impairment an opportunity for subsequent keratoplasty by arresting the inflammatory response and reducing the graft bed diameter. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/17363059/Amniotic_membrane_transplantation_combined_with_antiviral_and_steroid_therapy_for_herpes_necrotizing_stromal_keratitis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(06)01596-X DB - PRIME DP - Unbound Medicine ER -