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[Amniotic membrane transplantation in proven ulcerative herpetic keratitis: successful anti-inflammatory treatment in time].
Klin Monbl Augenheilkd 2008; 225(1):75-9KM

Abstract

BACKGROUND

In active herpetic keratitis, treatment with systemic and topical aciclovir together with low dosed-out steroids has been successful for few decades. However, in cases with severe herpetic ulcer and melting inflammation, emergency penetrating keratoplasty is necessary, which carries high risk for recurrent herpetic keratitis and rejection. The anti-inflammatory effect of amniotic membrane transplantation can be used as a first surgical step in order to gain time for planned penetrating keratoplasty. The results are analysed in this retrospective case series.

PATIENTS

Twelve eyes of 12 patients with clinically highly active herpetic ulcer without healing despite topical and systemic aciclovir were treated with amniotic membrane transplantation. Ten of 12 eyes (83 %) showed positive PCR testing for HSV-1. In one case, the molecular genetic result was negative, one analysis for HSV was not done. For surgery, debridement of the margins and the ground of the ulcer was done with steam heated cauterization. Afterwards, an amniotic membrane was made to cover the defect and fixed with single sutures. Peri- and postoperatively, the patients were treated with systemic aciclovir (4000 mg daily one week, 2000 mg daily 2 weeks) and gentamicin ointment topically.

RESULTS

Mean follow-up was 6.8 months (1-12.5). After 25 days in the mean (11-34), nine of 12 patients experienced an intact epithelial corneal surface together with a clinically clear reduction of the inflammation. Three other patients did not recover and were treated with emergency penetrating keratoplasty after 31 days in mean (25-35). Visual acuity did not improve after amniotic membrane transplantation except in one case.

CONCLUSION

The known anti-inflammatory potential of amniotic membrane causes a reduction of the inflammatory process in herpetic ulcer. A precondition is a sufficient antiherpetic and anti-inflammatory therapy and a decision for amniotic membrane transplantation in time in order to avoid an emergency penetrating keratoplasty. This gives the opportunity to perform planned penetrating keratoplasty with optimal HLA-match and postoperative immunosuppression.

Authors+Show Affiliations

Augenklinik, Universitätsklinikum der Heinrich-Heine-Universität, Düsseldorf. hspelsberg@web.deNo affiliation info available

Pub Type(s)

Clinical Trial
English Abstract
Journal Article

Language

ger

PubMed ID

18236375

Citation

Spelsberg, H, and J A. Reichelt. "[Amniotic Membrane Transplantation in Proven Ulcerative Herpetic Keratitis: Successful Anti-inflammatory Treatment in Time]." Klinische Monatsblatter Fur Augenheilkunde, vol. 225, no. 1, 2008, pp. 75-9.
Spelsberg H, Reichelt JA. [Amniotic membrane transplantation in proven ulcerative herpetic keratitis: successful anti-inflammatory treatment in time]. Klin Monbl Augenheilkd. 2008;225(1):75-9.
Spelsberg, H., & Reichelt, J. A. (2008). [Amniotic membrane transplantation in proven ulcerative herpetic keratitis: successful anti-inflammatory treatment in time]. Klinische Monatsblatter Fur Augenheilkunde, 225(1), pp. 75-9. doi:10.1055/s-2007-963779.
Spelsberg H, Reichelt JA. [Amniotic Membrane Transplantation in Proven Ulcerative Herpetic Keratitis: Successful Anti-inflammatory Treatment in Time]. Klin Monbl Augenheilkd. 2008;225(1):75-9. PubMed PMID: 18236375.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Amniotic membrane transplantation in proven ulcerative herpetic keratitis: successful anti-inflammatory treatment in time]. AU - Spelsberg,H, AU - Reichelt,J A, PY - 2008/2/1/pubmed PY - 2008/4/16/medline PY - 2008/2/1/entrez SP - 75 EP - 9 JF - Klinische Monatsblatter fur Augenheilkunde JO - Klin Monbl Augenheilkd VL - 225 IS - 1 N2 - BACKGROUND: In active herpetic keratitis, treatment with systemic and topical aciclovir together with low dosed-out steroids has been successful for few decades. However, in cases with severe herpetic ulcer and melting inflammation, emergency penetrating keratoplasty is necessary, which carries high risk for recurrent herpetic keratitis and rejection. The anti-inflammatory effect of amniotic membrane transplantation can be used as a first surgical step in order to gain time for planned penetrating keratoplasty. The results are analysed in this retrospective case series. PATIENTS: Twelve eyes of 12 patients with clinically highly active herpetic ulcer without healing despite topical and systemic aciclovir were treated with amniotic membrane transplantation. Ten of 12 eyes (83 %) showed positive PCR testing for HSV-1. In one case, the molecular genetic result was negative, one analysis for HSV was not done. For surgery, debridement of the margins and the ground of the ulcer was done with steam heated cauterization. Afterwards, an amniotic membrane was made to cover the defect and fixed with single sutures. Peri- and postoperatively, the patients were treated with systemic aciclovir (4000 mg daily one week, 2000 mg daily 2 weeks) and gentamicin ointment topically. RESULTS: Mean follow-up was 6.8 months (1-12.5). After 25 days in the mean (11-34), nine of 12 patients experienced an intact epithelial corneal surface together with a clinically clear reduction of the inflammation. Three other patients did not recover and were treated with emergency penetrating keratoplasty after 31 days in mean (25-35). Visual acuity did not improve after amniotic membrane transplantation except in one case. CONCLUSION: The known anti-inflammatory potential of amniotic membrane causes a reduction of the inflammatory process in herpetic ulcer. A precondition is a sufficient antiherpetic and anti-inflammatory therapy and a decision for amniotic membrane transplantation in time in order to avoid an emergency penetrating keratoplasty. This gives the opportunity to perform planned penetrating keratoplasty with optimal HLA-match and postoperative immunosuppression. SN - 0023-2165 UR - https://www.unboundmedicine.com/medline/citation/18236375/[Amniotic_membrane_transplantation_in_proven_ulcerative_herpetic_keratitis:_successful_anti_inflammatory_treatment_in_time]_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2007-963779 DB - PRIME DP - Unbound Medicine ER -