Abstract | BACKGROUND: PATIENTS: Twelve eyes of 12 patients with clinically highly active herpetic ulcer without healing despite topical and systemic aciclovir were treated with amniotic membrane transplantation. Ten of 12 eyes (83 %) showed positive PCR testing for HSV-1. In one case, the molecular genetic result was negative, one analysis for HSV was not done. For surgery, debridement of the margins and the ground of the ulcer was done with steam heated cauterization. Afterwards, an amniotic membrane was made to cover the defect and fixed with single sutures. Peri- and postoperatively, the patients were treated with systemic aciclovir (4000 mg daily one week, 2000 mg daily 2 weeks) and gentamicin ointment topically. RESULTS: Mean follow-up was 6.8 months (1-12.5). After 25 days in the mean (11-34), nine of 12 patients experienced an intact epithelial corneal surface together with a clinically clear reduction of the inflammation. Three other patients did not recover and were treated with emergency penetrating keratoplasty after 31 days in mean (25-35). Visual acuity did not improve after amniotic membrane transplantation except in one case. CONCLUSION: The known anti-inflammatory potential of amniotic membrane causes a reduction of the inflammatory process in herpetic ulcer. A precondition is a sufficient antiherpetic and anti-inflammatory therapy and a decision for amniotic membrane transplantation in time in order to avoid an emergency penetrating keratoplasty. This gives the opportunity to perform planned penetrating keratoplasty with optimal HLA-match and postoperative immunosuppression.
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Authors | H Spelsberg, J A Reichelt |
Journal | Klinische Monatsblatter fur Augenheilkunde
(Klin Monbl Augenheilkd)
Vol. 225
Issue 1
Pg. 75-9
(Jan 2008)
ISSN: 0023-2165 [Print] Germany |
Vernacular Title | Amnionmembrantransplantation bei gesicherter ulzerativer Herpeskeratitis: Erfolgreiche Entzündungshemmung zum richtigen Zeitpunkt. |
PMID | 18236375
(Publication Type: Clinical Trial, English Abstract, Journal Article)
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Topics |
- Amnion
(transplantation)
- Corneal Ulcer
(surgery)
- Humans
- Keratitis, Herpetic
(surgery)
- Male
- Middle Aged
- Treatment Outcome
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