RECURRENT CORNEAL PERFORATION REPAIR WITH AMNIOTIC MEMBRANE PLUG TECHNIQUE
Published 2022 - 26th ESCRS Winter Meeting
Reference: CR10 | Type: Cornea Day Case Presentations | DOI: 10.82333/9jk4-3015
Authors: Renato Correia Barbosa* 1 , Rita Gonçalves 1 , Ricardo Bastos 1 , Rui Avelino Resende 1
1Ophthalmogy Department,Hospital Pedro Hispano - Unidade Local de Saúde de Matosinhos,Matosinhos,Portugal
To report a case of a relapsing corneal perforation due to herpetic keratitis, in a 70-year-old male patient, treated with an amniotic membrane plug surgical technique.
Management of the patient, including the surgical procedure and pre- and post-operative periods, took place in Hospital Pedro Hispano – ULSM, in Matosinhos, Portugal. The described surgical treatment was performed by Dr. Rita Gonçalves and Dr. Ricardo Bastos.
A 70-year-old male patient had a history of three corneal perforations due to relapsing herpetic keratitis. Surgical repair using an amniotic membrane graft was tried two times, with recurrence of perforation shortly after both procedures. Due to this history of relapse, he was admitted a third time for surgery, and a new surgical technique was carried out.
First, the perforated graft applied during the last surgery was removed. Anterior iris synechiae were disrupted and necrotic tissue at the base of the ulcer was carefully removed. Then, an amniotic membrane fragment was rolled to a length of 2 mm. One end of the roll was plugged into the perforation, and the other end was spread over the defective stromal area. Crisscrossing sewing was used to anchor the plug inside the ulcer. Then, a single layer of amniotic membrane was trimmed and folded in half to become a basement membrane for reepithelization, and its edge was sutured to episcleral and corneal tissue. Finally, a larger piece of amniotic membrane was applied over the entire surface of the cornea and anchored with a continuous suture. A 0,3 mL bubble of 20% C3F8 mixed with air was injected into the anterior chamber to preserve its depth in the early postoperative period.
During the 14 months of follow-up, the perforation did not relapse. The patient maintained a deep anterior chamber, and anterior synechia did not occur.
Severe herpetic keratitis may lead to corneal perforation, which may relapse several times, even after conventional surgical treatment using an amniotic membrane graft. The management of those patients may present a complex challenge, especially when complications recur after all therapeutic options have been tried.
In this report, we present an example of an alternative surgical technique for the management of those complex cases.