AMNIOTIC MEMBRANE TRANSPLANT IN IDIOPATHIC BAND KERATOPATHY

Published 2023 - 27th ESCRS Winter Meeting

Reference: P158 | Type: Free Paper Submission | DOI: 10.82333/fddh-se19

Authors: Antonio Romero Titos ¹ , Jose Antonio Vilchez Gonzalez* ¹ , Francisco Manuel Hermoso Gonzalez ¹ , Patricia Alvarez Sanchez ² , Maria Del Carmen Gonzalez Gallardo ¹

¹Ophthalmology,Hospital Universitario Clinico San Cecilio,Granada,Spain, ²Ophthalmology,Complejo Hospitalario Universitario de Jaen,Jaen,Spain

Purpose

To evaluate epithelial healing and clinical recovery through slit-lamp examination and Visual Analog Scale (VAS) respectively after EDTA chelation combined with amniotic membrane transplant in a severe case of idiopathic band keratopathy

Setting

Ophthalmology department, Hospital Universitario San Cecilio, Granada, Spain

Methods

A 47-year-old male presented at the clinic complaining about foreign body sensation and vision loss during last year in both eyes. He had been prescribed EDTA eye drops three times per day along this period with no response. Visual Acuity (VA) was 20/60 in both eyes. In the slit-lamp examination a severe subepithelial calcic band was found including the visual axis. The patient had no ocular disease history and a systemic workup did not reveal another cause. A diagnosis of Idiopathic Band Keratopathy was made. Due to no PRK available, combined EDTA chelation plus Amniotic Membrane Transplant was proposed, first left eye.

Results

The procedure was accomplished under topical anesthesia. First an epithelial keratectomy was made with alcohol 16% and cotton swabs. Posteriorly, EDTA application during 3 minutes allowed the complete removal of subepithelial calcium leaving a smooth surface for the correct epithelial growth. Finally, with the purpose of faster and non painful recovery an Amniotic Membrane Transplant was made using a 10-0 Nylon to secure amniotic membrane to conjunctiva. Two layers were used, the first one with the epithelial side up and the second one with epithelial aspect face to the cornea. A treatment with therapeutic contact lens plus topical 0.1% Dexamethasone and 0.5% Moxifloxacin three times per day were prescribed.

Postoperative appointment consisted of: 24 hours, 1 week and 1 month in which epithelial healing and level of pain were recorded by slit-lamp and Visual Analog Scale (VAS) respectively. At the first day post operative the patient did not report any complaint in his left eye, resulting in VAS was: 1 and the therapeutic contact lens was in situ. In the 1 week appointment the contact lens and sutures were removed in the slit-lamp with no incidences. One month after surgery, the left eye achieved VA 20/25 with no pain history recorded (VAS=0)

Conclusion

EDTA chelation is one of the most extended options used to treat Band Keratopathy. After removal of epithelium usually a therapeutic contact lens is placed to support the growth of new epithelium. However, that is only a physical support without biological regenerative properties. Amniotic membrane not only provides a wide range of growth factors but also decreases the inflammatory response and risk of infection with a relatively simple procedure. Because of the previously exposed, patients can get a faster and non painful recovery after the surgery which is crucial in this pathology since most of the cases are bilateral.

In this case, our patient gets an asymptomatic full recovery by the first month postoperative gaining three lines of vision.