Sandwich Technique and Amniotic Membrane Transplantation as an Effective Method in Repairing Corneal Perforations.

Abstract

Purpose: To evaluate effectiveness of human amniotic membrane (hAM) transplantation in patients with nontraumatic corneal perforation.

Methods: This retrospective chart review included the patients who underwent hAM transplantation with sandwich technique between March 2020 and January 2023 at Ege University Hospital, Turkey. Medical records of the patients including demographic data, best-corrected visual acuity that was measured with Snellen chart, detailed ophthalmological examination, and the need for additional surgical intervention after hAM transplantation were evaluated. Complications and anatomical and functional results were presented.

Results: A total 9 eyes of 9 patients with nontraumatic corneal perforations were evaluated between 2020 and 2023. Size of perforation was ≤3 mm in all the eyes. The mean age of the patients was 67.77 ± 15.52. Female-to-male ratio was 1/8. Sandwich technique was used in all patients for hAM transplantation. Five (55.55%) cases had infectious etiology and 4 (44.44%) of them had inflammatory etiology. Of the infectious corneal perforations, 3 (33.33%) were herpes simplex virus-induced neurotrophic keratopathy and 2 (22.22%) were bacterial keratitis. The mean residence time of the amniotic membrane on the ocular surface was 21 ± 8.05 days. Tectonic keratoplasty was needed in 1 (11.11%) eye. Corneal patch grafting was required in 1 (11.11%) eye. Evisceration was performed in 1 (11.11%) eye of a patient with no light perception who had no visual prognosis. Amniotic membrane detachment was observed in one patient as a surgical-related complication associated with hAM transplantation.

Conclusion: hAM transplantation is one of the successful treatment methods in treatment of relatively small corneal perforation. Considering the difficulty of finding a donor cornea and the easier access to the amniotic membrane, it seems like a good alternative treatment to reduce or postpone the need for tectonic keratoplasty.