Resorbable and running suture for stable fixation of amniotic membrane multilayers: A useful modification in deep or perforating sterile corneal ulcers

Results of Resorbable and Running Sutured Amniotic Multilayers in Sterile Deep Corneal Ulcers and Perforations

PURPOSE

To present the results of a modified surgical technique for secure tightening and fixation of multilayer amniotic membranes (AMs) in sterile deep or perforating corneal ulcers.

METHODS

We retrospectively analyzed the data of patients suffering from corneal ulcers who had been treated between February 2016 and June 2018 with running and resorbable sutures to fixate multilayer AMs. The parameters analyzed were gender, age, etiology of corneal ulcer, ulcer diameter, corneal thickness (CST) before and after the microsurgical procedure as measured with optical coherence tomography, number of inlays, repeat surgical procedures, follow-up duration in months, and rate of success (defined as a stable anterior chamber with improved CST, a negative Seidel test, and no need for any microsurgical keratoplasty during the first 6 months after treatment). The results were statistically evaluated using the Wilcoxon test. A P-value ≤0.05 was considered to show a statistically significant difference.

RESULTS

The CST increased significantly after AM transplantation (from 206.26 ± 114.93 μm at baseline to 454.70 ± 244.08 μm at 1-3 months; P < 0.001). Repeat multilayer transplantation was required in 7 of the 23 patients included (30.4%), in 6 of whom the treated eye was stable at month 6. In 2 of the 23 patients, perforating keratoplasty became necessary. One patient also demanded such a procedure to improve his visual acuity. The success rate was 91.3% (n = 21).

CONCLUSIONS

Running resorbable suture fixation of multilayer AMs proved to be an efficient means for the treatment of noninfectious deep or small perforating corneal ulcers.

Amniotic Membrane as a Main Component in Treatments Supporting Healing and Patch Grafts in Corneal Melting and Perforations

Purpose

To report on surgical approaches using amniotic membrane applications and patch grafts in corneal melting and perforations. Anatomical and functional results, including advantages and disadvantages of the interventions, will also be explored.

Methods

A five-year retrospective analysis of 189 surgical treatments involving corneal melting with perforation was performed. In one evaluated treatment type, a graft of amniotic membrane, often folded one to three times, was sutured with the epithelial side facing the previously mechanically debrided corneal tissue. A larger monolayer amniotic patch was then sutured, with the epithelial side facing the top of the first membrane, to the perilimbal conjunctiva. For corneal patch grafts, the size-fitting technique of graft trephination was applied, and the donor-recipient junctions were sewn with interrupted sutures. All the procedures were evaluated, noting outcomes and complications of surgery, preoperative and postoperative visual acuities, postoperative intraocular pressures, graft rejection, and other late comorbidities and complications.

Results

We performed 119 amniotic membrane applications (63%) and 70 corneal patch grafts (37%). Anatomical reconstruction of the anterior chamber was achieved in 157 eyes, of which 102 eyes (86%) received an amniotic membrane and 55 eyes (79%) were treated with the patch graft technique. In 63 eyes (33%), more than one amnion or graft treatment was necessary to close the corneal perforation.

Conclusions

The success of medical and surgical management depends on the cause of corneal melting, and amniotic membrane applications often require further intervention; nevertheless, patch grafts deliver better tectonic reconstruction than amniotic membrane alone.