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DALK success rate in neurotrophic keratopathy rises with application of amniotic membrane graft
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ROME — Application of amniotic membrane graft enhances the success rate of deep anterior lamellar keratoplasty in eyes with neurotrophic keratopathy, according to one surgeon.
"In these eyes with a tendency towards persistent epithelial defect, the application of amniotic membrane following DALK provides long-term stabilization of the epithelium," Kenneth R. Kenyon, MD, said at the annual joint meeting of Ocular Surgery News and the Italian Society of Ophthalmology.
After standard DALK, an amniotic membrane overlay graft approximately 15 mm in diameter is applied and secured with either tissue adhesives or multiple interrupted or running sutures. A soft contact lens is applied, and a small 2- to 3-mm lateral tarsorrhaphy is performed to provide longer duration surface protection.
"Postoperative management is remarkably simple because you don't have to depend on high doses of topical steroids. The eyes become rapidly uninflammed as there is no risk of rejection. The amnion either dissolves or is removed typically after 1 month," Dr. Kenyon explained.
In his series with an average follow-up of 20 months and up to 6 to 7 years, Dr. Kenyon achieved a 90% success rate.
"These patients may have no more than 50% chances of success with conventional means. I believe this represents a significant advance in the rehabilitation of these high-risk corneas," he said.
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