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Amniotic Membrane Transplantation for Symptomatic Bullous Keratopathy
Renato T. F. Pires, MD;
Scheffer C. G. Tseng, MD, PhD;
Pinnita Prabhasawat, MD;
Vilavun Puangsricharern, MD;
Steven L. Maskin, MD;
Jae Chan Kim, MD;
Donald T. H. Tan, MD
Arch Ophthalmol. 1999;117:1291-1297.
Objective To determine whether amniotic membrane transplantation can be used to treat symptomatic bullous keratopathy displaying poor visual potential.
Methods Amniotic membrane transplantation was performed at 5 centers on 50 consecutive eyes (50 patients) with symptomatic bullous keratopathy and poor visual potential. The underlying causes of bullous keratopathy included aphakia (9 eyes), pseudophakia (19 eyes), failed grafts (9 eyes), and others (13 eyes).
Results During the follow-up period of 33.8 weeks (3-96 weeks) after amniotic membrane transplantation, 43 (90%) of 48 eyes with intolerable pain preoperatively became pain free postoperatively. Among the 5 eyes with residual pain, 3 received repeated amniotic membrane transplantation, 1 required a conjunctival flap for pain relief, and 1 had reduced pain. Epithelial defects in 45 (90%) of 50 eyes created and covered by amniotic membrane healed rapidly within 3 weeks. Only 4 eyes (8%) showed recurrent surface breakdown. Epithelial edema or bullae recurred in a smaller area in 5 eyes (10%) and pseudopterygium developed in 1 eye.
Conclusion Amniotic membrane transplantation can be considered as an alternative to conjunctival flaps in alleviating pain, promoting epithelial healing, and preserving cosmetic appearance in patients with symptomatic bullous keratopathy and poor visual potential.
From the Ocular Surface and Tear Center, Department of Ophthalmology, Bascom Palmer Eye Institute (Drs Pires and Tseng) and the Department of Cell Biology and Anatomy, University of Miami School of Medicine, Miami, Fla (Dr Tseng); the Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok, Thailand (Dr Prabhasawat); the Department of Ophthalmology, Chulalongkorn University Hospital, Bangkok (Dr Puangsricharern); Cornea and External Disease of the Eye, Tampa, Fla (Dr Maskin); the Department of Ophthalmology, Yong-San Hospital, Chung-Ang University College of Medicine, Seoul, Korea (Dr Kim); and the Singapore National Eye Center, Singapore (Dr Tan).
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