A controlled study of amniotic membrane transplantation for acute Pseudomonas keratitis

Objective: To evaluate the efficacy of amniotic membrane transplantation (AMT) to improve the outcomes of acute Pseudomonas keratitis as compared with a control group. Design: Prospective interventional case series with retrospective controls. Participants: We studied 14 eyes with Pseudomonas keratitis as the AMT group and 11 eyes with Pseudomonas keratitis as the control group. Methods: Eyes in the AMT group were treated with antibiotic therapy followed by single-layer AMT at 2 to 3 days. Eyes in the control group received only antibiotic therapy. Patients were followed for 11.1 +/- 2.4 months. Results: In the AMT group, pain significantly decreased from a mean score of 2.4 +/- 0.5 preoperatively to 1.1 +/- 0.9 at day 2 postoperatively (p < 0.001). Corneal epithelial defects healed completely within 13.2 +/- 2.6 days in the AMT group compared with 15.5 +/- 3.4 days in the control group (p = 0.07). At final follow-up visits, the sizes of corneal opacity and deep neovascularization were not different between the 2 groups. However, the mean score for density of the corneal opacity was significantly less in the AMT group compared with the control group (2.1 +/- 0.4 vs 2.5 +/- 0.7, respectively, p = 0.04). Although the best corrected visual acuity using hard contact lenses was not different between the 2 groups, uncorrected visual acuity was better in the AMT group (0.45 +/- 0.22 logMAR) than in the control group (0.71 +/- 0.32 logMAR, p = 0.03). No patient in either group developed significant corneal thinning or perforation. Conclusions: AMT in acute Pseudomonas keratitis was associated with immediate pain relief, less density of the final corneal opacity, and better uncorrected visual acuity at the final follow-up visit.