Clinical Study Of Amniotic Membrane Transplantation For Persistent Epithelial Defects(PED) And Refractory Corneal Ulcer

Purpose: To Investigate the efficacy of amniotic membrane transplantation for persistent epithelial defects(PED) and refractory corneal ulcer.Methods: A total of 141 eyes of 141 patients with persistent epithelial defects(PED) and refractory corneal ulcer caused by chemical burn, thermal burn and post keratoplasty, from November 2009 to November 2012, in Shenyang Aier Eye Hospital were retrospectively reviewed. The patients with damaged area of corneal rim or corneal ulcer proportion more than 1/4 quadrant or the depth of the corneal ulcer over 1/2 total corneal thickness were excluded. Meanwhile, the patients with corneal infection verified by the confocal microscopy, corneal scraping or tissue culture as well as the hypophasis caused by the palpebral trauma were not included. The remnant 122 patients underwent the conserved treatment with drug and contact lens for two weeks. Of 44 eyes(44 patients), the painful symptom, photophoby and tearing did not become better. The recovery of patient with epithelial defects and corneal ulcer was less than 70 percent and the diminishment of the disorder was not obvious. The edema of the stroma and keratic precipitate reduced slightly. Therefore, the overlay or sandwich technique of glycerinum-processed amniotic membrane transplantation was applied to prevent the progress of the disease. The follow up after surgery is 8.8±4.7 months and the post-operative symptom was recorded. Best corrected visual acuity(BCVA) was assessed by Pair T test. Epithelial healing and the recover of the corneal ulcer were evaluated by chi-square test. Rank sum test was applied to assess the transpancy of the cornea.Results: Ocular pain of all 44eyes(44 patients) relased intensively. The mean best corrected visual acuity BCVA was 0.52±0.46 log MAR. There was significantly different between pre-operative and post-operative BCVA(P<0.05). Complete epithelialisation occurred in 42eyes(42 patients) at 23.7±9.8 days postoperatively. There was significantly different between pre-operative and post-operative corneal epithelialization(P<0.05). Two eyes of two patients with less than 30% epithelialization of corneal ulcer progressively suffered from corneal stromal infiltration and keratic precipitate. 1 eyes underwent the penetrating keratoplasy. However, another eye with the entophthalmia indication of B scan suffered the ophthalmectomy without effective control of medication. Pre-post operative coreal transparency had statistic difference(P <0.05).Conclusion:(1) Amniotic membrane transplantation was effective to release the pain of corneal ulcer.(2) The transparency of the edematous cornea improved greatly.(3) Glycerine-processed amniotic membrane transplantation was effective to promote the corneal epithelialization.(4) Our study indicated that amniotic membrane could greatly promoted the recovery of the corneal ulcer.