Impact of adjuvant amniotic membrane transplantation in infectious ulcerative keratitis

Purpose To evaluate the effectiveness of cryopreserved human amniotic membrane transplantation (hAMT) in patients with infectious ulcerative keratitis. Methods A retrospective cohort study based on medical records of patients who underwent hAMT procedure over a 2-year period (2020-2021) was conducted at Ege University Hospital, Turkey. Cryopreserved hAM was used. Best corrected visual acuity (BCVA) was measured with the Snellen chart. Detailed ophthalmological examination was performed at all visits. Treatment success was defined as complete healing including disappearance of corneal infiltrates, epithelial defect closure, reduction in anterior segment reaction. Results A total of 13 eyes of 12 patients were diagnosed with ulcerative keratitis between 2020 and 2021. hAMT was performed in severe keratitis patients in which corneal infiltrates extending to middle to deep stromal and patients with neurotrophic component, in other words, having trouble for wound healing. The mean age was 60.9 +/- 18.7 years, and 66.6% of the patients were male. Average ulcer horizontal diameter was 9.7 +/- 2.8 mm. A single-layer human amniotic membrane (hAM) was transplanted 92.3% of eyes. Overlay technique was used in all patients for hAMT. The mean residence time of the amniotic membrane on the ocular surface was 14.1 +/- 10.2 days. The mean time from the first presentation to the hAM transplantation was 9.7 +/- 6.8 days. The average hospitalization time of all patients was 15 +/- 12.1 days, pre-hAMT was 10.2 +/- 7.3 days and post-hAMT was 4.8 +/- 9.1 days. The mean follow-up time was 3 months. Recovery response was positive in 76.9%. Average healing time was 32.1 +/- 14.04 days. Conclusions hAMT was effective in the treatment of infectious ulcerative keratitis by accelerating and supporting wound healing. Performing hAM transplantation at the early stages of the disease and prolonged residence of membrane on the ocular surface increase the success of the treatment and moreover shortens hospitalization time.