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Amniotic membrane transplant shows efficacy in treating herpes stromal keratitis
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Multilayer amniotic membrane transplantation combined with antiviral medication and corticosteroid therapy appears effective for treating patients with herpes necrotizing stromal keratitis, according to a study by researchers in China.
Weiyun Shi, MD, PhD, and colleagues reviewed outcomes for 15 patients treated for herpes necrotizing stromal keratitis, persistent corneal inflammation and an impending ulcer. In all cases, the patients had not adequately responded to 2 weeks of treatment with topical and systemic antiviral drugs, according to the study.
Surgeons performed multilayer amniotic membrane transplantation in conjunction with postoperative antiviral therapy, with corticosteroids also administered as appropriate.
At 8.9 months mean follow-up, visual acuity had improved by two or more lines in 14 eyes, the authors reported.
In addition, central corneal ulcers had healed completely at an average of 2 weeks postop and paracentral ulcers had healed completely at a mean of 2.1 weeks.
Corneal stromal thickness was restored at an average of 2.4 weeks in eyes with central ulcers and at 2.6 weeks in eyes with paracentral ulcers, according to the study.
"Superficial epithelial cells, together with small basal epithelial cells, gradually migrated to the surface of [amniotic membrane] on postoperative weeks 1 to 3. There were corneal nebulae in 11 eyes, corneal maculae in three eyes and a corneal leukoma in one eye at the end of follow-up. No recrudescence occurred in any eye," the authors said.
"[Multilayer amniotic membrane transplantation] provides patients with marked scars and visual impairment an opportunity for subsequent keratoplasty by arresting the inflammatory response and reducing the graft bed diameter," they said.
The study is published in the August issue of Ophthalmology.