A Different Amniotic Membrane Transplantation Technique In Necrotizing Stromal Keratitis

To report a surgical approach for a case of necrotizing stromal keratitis developed due to uncontrolled topical steroid use in a patient with a history of previous herpes keratitis.

Eskişehir Osmangazi University, Eskişehir, Turkey.

A 60-year-old male patient applied to our clinic due to increasing redness and vision loss in his right eye 3 months after cataract surgery. In the patient's history, he applied dexamethasone eye drops without consulting a doctor due to redness in his right eye. The visual acuity was measured at 2/60 in the right eye. Biomicroscopic examination revealed ectropion in the lower eyelid, a shallow anterior chamber, a melting area in the inferior corneal quadrant, and evidence of Seidel’s sign. As a result of these findings, the patient was evaluated as having necrotizing stromal keratitis due to uncontrolled steroid use on the background of neurotrophic keratopathy. The patient was initiated on acyclovir tablets 5x400 mg, oral vitamin C preparate 1x1, tetracycline tablets 1x1, moxifloxacin eye drops 4x1, and tropicamide eye drops 3x1. Double-layer amniotic membrane (AM) transplantation was performed three times, but each time it was observed that the AM was separated from cornea after a short time. Thereupon, the technique was changed, and the AM was placed towards the anterior chamber to fill the perforation area, and a new AM was transplanted with tissue adhesive on the cornea. In addition, the patient underwent ectropion repair. During the follow-up examination, it was observed that the perforation area had closed, the AM had begun to melt, and there were bullous changes in the cornea. Finally, the patient underwent tectonic penetrating keratoplasty.

Uncontrolled topical steroid use on the background of neurotrophic keratopathy can lead to corneal melting and perforation. Amniotic membrane transplantation techniques are beneficial in the treatment.