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Combined treatment of corneal ulcer: photoactivated riboflavin cross-linking and amniotic membrane transplantation

Poster Details

First Author: D.Simeonova BULGARIA

Co Author(s):    M. Boyadzhieva   Y. Manolova   C. Grupcheva              

Abstract Details


We present a rare case of severe corneal ulceration with undiagnosed infection, presumed to be bacterial managed with photo-activated riboflavin cross linking(PACK-CXL) and amniotic membrane transplantation (AMT).


Medical University of Varna �â�€�œProf. Dr. Paraskev Stoyanov�â�€� Specialized Eye Hospital - Varna, Bulgaria


A 73-year-old woman patient with ultimate eye was diagnosed with vision-threatening paracentral corneal ulcer due to postoperative bullous kerathopathy. Symptoms included photophobia, pain, blurred vision, discharge and the sensation of foreign body in the eye. Slit lamp examination revealed conjunctival injection, paracentral corneal ulceration with surrounding epithelial infiltration, stromal �Ð�¾�Ð�µdema and 1.5mm hypopion. The patient was admitted at the hospital. The initial antimicrobial therapy appeared ineffective and the microbiology was negative. Considering the situation decision of combined treatment with PACK-CXL and AMT was taken, using established protocol in the unit.


Patient reported subjective improvement 24 hours after surgery. Objectively in the first week after the treatment the ulcer started to heal .On biomicroscopy we observed decrease corneal infiltration and re-epithelization. Total corneal epithelization with scarring and improved visual acuity was encountered in 4 weeks


PACK-CXL and AMT can be considered as a treatment of last resort corneal ulceration. It combines the antimicrobial properties riboflavin photoactivation with healing potential of the amniotic membrane.FINANSIAL DISCLOSURE: none

Financial Disclosure:


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