Management of acute ulcerative and necrotising herpes simplex and zoster keratitis with amniotic membrane transplantation

Aim: To report promoted healing of acute ulcerative and necrotising herpetic keratitis after amniotic membrane transplantation (AMT). Methods: Retrospective, non-comparative case series of seven patients with acute ulcerative and necrotising herpetic stromal keratitis. Single or multilayer AMT with epithelial side facing up was performed. The main outcome measures were wound healing of the corneal ulcers and decrease of stromal inflammation. Results: The mean follow up was 10.7 (SEM 1.4) months ( range 5 - 15 months). AMT was performed once in five cases, and twice in further two. Improvement of stromal inflammation was noted within 16.4 (2.5) days ( range 7 - 28 days). Epithelial defects healed within a mean of 17 (2.7) days ( range 7 - 28 days). Vision improved in all but two patients. No serious side effects occurred during the follow up. Conclusions: Although performed in an uncontrolled and non-randomised series of patients, these findings indicate that the AMT shows promise in selected cases for the restoration of ocular surface integrity, reduction of stromal inflammation, and improvement of vision in acute ulcerative and necrotising herpetic keratitis.