[Treatment of severe marginal ulcerative keratitis by glucocorticoids combined with amniotic membrane transplantation].

Abstract

Objective: To explore the clinical effectiveness of glucocorticoids combined with amniotic membrane transplantation in the treatment of severe marginal ulcerative keratitis. Methods: A retrospective case series study was conducted. Data from 10 patients (10 eyes) with marginal ulcerative keratitis who received glucocorticoid administration combined with amniotic membrane transplantation at the Eye Hospital of Shandong First Medical University from October 2017 to May 2022 were collected. There were 6 males and 4 females with an average age of 61.3 years. All patients underwent corneal scraping, bacterial culture, fungal culture, and confocal microscopy examination to exclude bacterial, fungal, and Acanthamoeba infections. The main indicators included visual acuity, intraocular pressure, corneal ulcer healing, and resolution of stromal edema. Results: The follow-up after surgery ranged from 1 to 18 months. Postoperative visual acuity in all patients was significantly improved compared to preoperative levels. Among the 10 patients, 5 had partial abnormalities in blood immune indicators. For patients with purulent exudates attaching to the endothelial surface as shown on anterior segment optical coherence tomography, anterior chamber irrigation was performed to remove the exudates during surgery. Corneal ulcers healed within 1 to 2 weeks postoperatively, with negative corneal fluorescein stainings. Stromal edema completely resolved within 1 month. The superficial large amniotic membrane autolyzed or fell off within 7 to 10 days, while the inner amniotic membrane remained closely attached to the ulcer surface until the ulcer healed, shrinking as the ulcer surface decreased. Epithelial cells around the ulcer proliferated and gradually crawled to the surface of the small amniotic membrane on the ulcer surface, covering the corneal ulcer surface. The deep fibrous tissue of the ulcer and the amniotic membrane fused, filling the defect area of the ulcer tissue together. Conclusion: Patients with severe marginal ulcerative keratitis treated by glucocorticoid administration combined with amniotic membrane transplantation achieved favorable visual acuity improvement and corneal ulcer healing.