Combined amniotic membrane transplant and anterior stromal puncture in painful bullous keratopathy: clinical outcome and confocal microscopy

Gregory, Maria Elena; Spiteri-Cornish, Kurt; Hegarty, Bernardine; Mantry, Sanjay; Ramaesh, Kanna

doi:10.3129/i10-116

Cited by 18 publications

(9 citation statements)

References 22 publications

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“…Confirmation of the above can be aided using a laser scanning confocal microscopy or anterior-segment optical coherence tomography [7,[23][24][25][26], which was not available in our unit at the time. Further evaluation of the presence of epithelialization and/or absence of bullae can help better understand the mechanisms of successful pain reduction post-AMT [27]. Due to the retention of the amniotic membrane, the inlay method of AMT may not be suitable for patients awaiting endothelial keratoplasty.…”

Section: Discussionmentioning

confidence: 98%

Long-term symptomatic relief of bullous keratopathy with amniotic membrane transplant

2015

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The purpose of this study was to assess the long-term outcome of patients with symptomatic bullous keratopathy after amniotic membrane transplant. A retrospective cohort study includes that 20 patients with symptomatic bullous keratopathy, who have underwent amniotic membrane transplant at the Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital & Alice Ho Miu Ling Hospital, Hong Kong between 04/1998 and 06/2011, were invited back. Clinical examination was performed, including, pain score assessment (pain score out of 10), epithelial healing, and vision. A total of 21 eyes of 20 patients returned for our study. The majority of eyes experienced pain reduction (94 %), with a significant mean pain score difference of 6.8 ± 2.6, 2-tail p < 0.001 (99 % CI 4.9-8.7). The mean pre-operative and post-operative pain scores were 7.3 ± 2.9 and 0.5 ± 1.0, respectively. 16 eyes (76 %) were completely pain free, and 10 eyes (47 %) remained symptom free after a mean follow-up of 39.0 ± 36.3 months (range 5-171 months). The median epithelial healing time was 2 weeks (range 1-20 weeks). Amniotic membrane transplant may be considered as a longer-term treatment for bullous keratopathy patients, especially in patients with poorer visual prognosis, but it may also be used as an interim measure for patients awaiting corneal transplant.

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Section: Discussionmentioning

confidence: 98%

Long-term symptomatic relief of bullous keratopathy with amniotic membrane transplant

2015

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“…The fibrosis has been shown to produce strong adhesion complexes between epithelium and corneal stroma and act as a barrier to sub-epithelial fluid accumulation preventing subsequent bullae and corneal ulceration. 10,23,25,26 While this study has shown the efficacy of SK for resolution of PCED-associated corneal ulceration, the procedure does not improve vision. Corneal clarity was not objectively measured in this study; however, the corneas following SK were subjectively less clear when compared to preoperatively.…”

Section: Discussionmentioning

confidence: 65%

“…Superficial corneal stromal fibrosis is an important component of the therapies described for treating PCED‐associated corneal ulceration and bullous keratopathy. The fibrosis has been shown to produce strong adhesion complexes between epithelium and corneal stroma and act as a barrier to sub‐epithelial fluid accumulation preventing subsequent bullae and corneal ulceration …”

Section: Discussionmentioning

confidence: 99%

Superficial keratectomy as a treatment for non‐healing corneal ulceration associated with primary corneal endothelial degeneration

Bayley

Read

Gates

2018

Veterinary Ophthalmology

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Objective To analyze a study population of dogs with primary corneal endothelial degeneration (PCED) for information on the patterns of disease and to report the efficacy of superficial keratectomy (SK) for resolution of non‐healing corneal ulcers associated with PCED. Animals studied Primary corneal endothelial degeneration was diagnosed in 238 dogs between 1998 and 2017. Corneal ulceration associated with PCED was present in 89 dogs (109 eyes), of which 47 eyes were treated with SK. Procedures A retrospective assessment of medical records was performed to determine the signalment patterns of PCED, and the success rate of the SK procedure for resolving PCED‐associated corneal ulceration. Descriptive statistics were reported on the signalment of PCED cases, with odd ratios and confidence intervals calculated to detect breed predispositions. Results Primary corneal endothelial degeneration was diagnosed in 238 dogs, 40.8% were female and 59.2% were male, with a mean age at diagnosis of 11.4 years. Dachshunds, Dalmatians, English Springer Spaniels, Welsh Springer Spaniels, Chihuahuas, Cocker Spaniels, and Golden Retrievers were significantly over‐represented. All PCED‐affected Dalmatians developed associated corneal ulceration. Follow‐up information was available for 41/47 eyes treated with SK. At the first reassessment, 87.8% were healed which increased to 97.6% with subsequent monitoring. Four eyes (9.8%) had late corneal ulcer occurrence following SK, at a median time following SK of 182 weeks post‐surgery. Conclusions Superficial keratectomy was an effective option for resolving painful non‐healing corneal ulcers associated with PCED. Dalmatians may be at increased risk of developing PCED‐associated corneal ulceration.

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“…After a mean follow-up period of 16 months, 3 of 4 patients noted persistent and complete pain resolution, while 1 patient had recurrence of pain after contact lens removal. Gregory et al described the use of amniotic membrane transplantation, anterior stromal puncture, and balafilcon A bandage contact lens placement (removed after 6 weeks) in 12 eyes of 12 patients with bullous keratopathy, of which 11 noted complete symptom resolution with a mean follow-up of 67 weeks [24]. It should be noted that symptom resolution in these reports cannot be attributed entirely to contact lens use, given the other concurrent interventions.…”

Section: Bullous Keratopathymentioning

confidence: 99%

Contact Lenses in the Management of Corneal Dystrophies

Farooq

Colby

2019

Klin Monatsbl Augenheilkd

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Among the group of diseases comprising corneal dystrophies, there are a number for which contact lenses may be considered. For example, soft contact lenses may be beneficial in the management of recurrent corneal erosions and advanced bullous keratopathy and may lead to disease attenuation in some conditions. They also may be used in conjunction with surgical procedures to promote tissue healing and patient comfort in the postoperative period. Rigid contact lenses may be beneficial in the setting of irregular astigmatism. The present review of the literature will discuss the use of contact lenses in the management of corneal dystrophies.

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Combined amniotic membrane transplant and anterior stromal puncture in painful bullous keratopathy: clinical outcome and confocal microscopy

Cited by 18 publications

References 22 publications

Long-term symptomatic relief of bullous keratopathy with amniotic membrane transplant

Long-term symptomatic relief of bullous keratopathy with amniotic membrane transplant

Superficial keratectomy as a treatment for non‐healing corneal ulceration associated with primary corneal endothelial degeneration

Contact Lenses in the Management of Corneal Dystrophies

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