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First Author: M.Barbany Rodriguez SPAIN
Co Author(s): A. Salvador Playà I. Sassot Cladera E. Pedemonte Sarrias
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To evaluate the efficacy and possible use of superficial keratectomy with amniotic membrane transplantation in special cases of symptomatic bullous keratophaty, where other surgical options are not possible. We present the case of a patient with a bullous keratopathy due to endothelial damage caused by the contact of a silicone bubble in the anterior chamber. As for his ophthalmic history, he had had a complicated retinal detachment that required the collocation of a scleral band device and after which a visual acquity of luminous perception was left. Taking into account this background, the corneal transplantation and the conjunctival flap were dismissed as options. In an attempt to regularize the ocular surface and achieve subjective comfort, we performed a superficial keratectomy with amniotic membrane transplantation.
Hospital Universitari Mútua de Terrassa. Department of Ophthalmology.
We performed a lamellar manual dissection of the superficial cornea. After that, the amniotic membrane was sutured to the involved ocular surface and secured with interrupted 10-0 nylon sutures and a continuous suture.
With the lamellar keratectomy we achieve a subjective comfort, as it causes the laceration of superficial corneal nerves and produces an anterior stromal fibrosis. The amniotic membrane, with its unique characteristics, facilitates the regularization of the ocular surface, the healing of the wound and promotes the re-epithelialization. Furthermore, it has anti-inflammatory properties and temporarily covers and protects the corneal surface. After a follow-up of 17 months, our patient remains assymptomatic with a regular corneal surface and a part of amniotic membrane can be still observed.
In special cases like this one, where we can not perform a corneal transplantation or a conjunctival flap, we should consider this surgical approach as a solution to alleviate the symptomatology and the persistent epithelial defects.