Amniotic Membrane Transplantation For The Treatment Of A Traumatic Stromal Ulcer And The Role Of Anterior Segment Optical Coherence Tomography In Monitoring Healing: A Case Report

This case report aims to describe the successful treatment of a 35-year-old male with a traumatic stromal ulcer in his left eye (OS), using amniotic membrane transplantation (AMT). Additionally, the role of anterior segment optical coherence tomography (AS-OCT) in monitoring the healing process of the cornea is highlighted.

Centro Hospitalar de Entre o Douro e Vouga (CHEDV), Santa Maria da Feira, Portugal.

The patient presented with complaints of redness, tearing, and irritation in the OS following a corneal trauma with a metallic object. On the examination, biomicroscopy of the OS revealed an nasal intrastromal metallic foreign body with surrounding edema and infiltrate, without disruption of the Descemet’s membrane. Anterior chamber was well formed. The foreign body was removed and the patient was initially treated with topical antibiotics and steroids. He was observed weekly, and there was no significant improvement after one month of follow-up. AS-OCT revealed localized loss of corneal tissue in the stroma layer and an ulcer with sharply defined edges. Therefore, the decision was made to perform an AMT. An epithelial debridement was conducted, followed by the application of multiple small inlay grafts in layers. The grafts were filled with biological tissue adhesive, which was used to cover the entire depth of the corneal ulcer. The overlay AMT was placed with the epithelial basement membrane side down and secured by six interrupted 10-0 polyglactin sutures surrounding conjunctiva. The patient was then started on topical antibiotics and steroids. After two weeks, the edema and infiltrate decreased, and the ulcer healed with the formation of a scar. At the two-month follow-up, the BCVA was 20/20, and there were no signs of recurrence. The scar remained stable, and the cornea appeared healthy. AS-OCT at the healed site revealed a stable surface.

Traumatic stromal ulcer is a serious ocular surface disease that may result in vision loss. AMT has been shown to promote rapid re-epithelialization, reduce inflammation, and provide a scaffold for tissue repair. Growth factors, cytokines, and anti-inflammatory agents are also found in the amniotic membrane, which can aid in the healing process. AMT is a well-established technique in the treatment of ocular surface disorders. The healing of the stroma can be delineated on high-resolution OCT imaging, which can aid in documenting and characterizing the exact nature of the healing pattern.