Amniotic membrane transplantation in treatment of persistent corneal ulceration after severe chemical and thermal eye injuries

Purpose: To analyze results of amniotic membrane transplantation (AMT) in treatment of corneal ulceration after severe chemical and thermal injuries. Methods: Analysis of 55 AMT in 53 patients (53 eyes) with corneal ulceration and limbal deficiency 180-360 degrees of the limbus after grade 4-6 (Dua classification, 2001) chemical and thermal injuries was performed. Mean terms of the operation were 46.1 +/- 46.4 days after the injury (range 8-181 days). Preoperative visual acuity (VA) was <0.01 in 33/53 patients (62.3%). Mean follow-up period was 8.8 +/- 10.1 months (range 1.5-46 months). Results: Further corneal ulceration was prevented in 54/55 cases (98.1%), cornea epithelialized after 42/55 AMT (76.3%). Mean terms of corneal epithelialization were 24.2 +/- 26.7 days after AMT (range 6-123 days). Corneal defect recurred in 3/42 successful cases (7.1%). Limbal deficiency of different extent with subsequent corneal conjunctivalization developed in all successful patients. The VA was >= 0.01 (range 0.01-1.0) in 23/42 patients (54.8%) with corneal epithelialization. The VA at the last visit was improved on 2 and more lines on the eye chart compared to preoperative VA in 15/42 patients with corneal epithelialization (35.7%), did not change in 18/42 successful patients (42.9%), and decreased on one line in 9/42 of these patients (26.2%). Symblepharon developed in 23/42 successful patients (54.7%). Conclusions: Amniotic membrane transplantation may stop ulceration and promote corneal epithelialization in the majority of patients with the most severe chemical or thermal eye injuries in case of timely application of the operation and adequate fixation of the AMT graft.