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Treatment of keratitis with steam thermocautery, amnion membrane and fibrin glue

Poster Details

First Author: M.Karageorgieva BULGARIA

Co Author(s):    B. Kutchoukov   N. Botsevska   A. Yaneva        

Abstract Details



Purpose:

To present the technique and indications for thermocautery followed by amnion transplantation with fibrin glue as well as to introduce the method into everyday clinical practice. It also presents the first results on Bulgarian patients. Introduction: Microbial keratitis (bacterial or mycotic) and viral keratitis are usually treated with topical and, occasionally with systemic therapy. However, in some cases fortified drops, although used with high frequency, fail to provide healing. This may lead to enlargement and deepening of the corneal infiltrate, to corneal ulcer formation and possible perforation. In such cases of keratitis, resistant to the usual topical therapy a steam thermocautery procedure to the inflamed area of the cornea may result in fast healing of the ulcer. Then several layers of amnion membrane are glued over the treated area.

Setting:

Interventional case series report. Thermocautery procedure was performed in an operating room under sterile conditions. A steam thermocauter Mod. Freiburg for corneal ulcers (Geuder, art.Nr. S 02964) in combination with filled with water Saluta –†icolette steam inhaler (Fahl, art.Nr.54000) was used. When water starts to evaporate the tip of the Geuder thermocauter is applied at the infected area of the cornea after gentle abrasion.

Methods:

A series of 3 patients with resistant to local therapy keratitis with duration more than 2 months was treated with steam thermocautery (2 cases of bacterial keratitis and 1 case of stromaal viral keratitis). Then 5-6 layers of amniotic membrane were applied above the treated corneal ulcer. Fibrin glue (TISSEEL, Baxter) was used between the layers. 10/0 nylon sutures were applied at the corners of the transplant. At the end a soft bandage silicone hydrogel lens was applied. A combination of topical antibiotic drops continued to be used after the procedure.

Results:

Epithelisation of all treated corneas with a variable degree of residual stromal opacification was observed 4-6 weeks after the procedure (thermocautery combined with amnioplasty with fibrin adhesive). None of the patients deteriorated to Descemet perforation or underwent urgent penetrating keratoplasty during this period or later.

Conclusions:

A combined procedure of corneal thermocautery and amnioplasty with fibrin glue is an effective addition to the topical therapy in cases of resistant to treatment infectious keratitis. This approach may prevent corneal perforation and/or the need for urgent penetrating keratoplasty. Corneal transplantation during a quiescent period may be planned with better results expected (both anatomical and visual). FINANCIAL INTEREST: NONE

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