Lamellar keratectomy combined with multilayer amniotic membrane transplantation and bandage contact lens for necrotizing HSK

Objective To evaluate the clinical effectiveness of application of lamellar keratectomy combined with multilayer amniotic membrane transplantation and bandage contact lens, systemic antiviral and topical corticosteroid therapy to eyes with necrotizing HSK. Methods Data were retrospectively analyzed of 15 patients (15 eyes) with necrotizing HSK that could not heal or aggravated after 7 days of antiviral therapy. Lamellar keratectomy combined with multilayer amniotic membrane transplantation and bandage contact lens wear with local corticosteroid eye drops and systemic antiviral medications were performed on the eyes; follow up was at least 6 months for postoperative cornea. Results Fourteen eyes achieved inflammation remission within 7 to 30 days. Corneal epithelium healing time under bandage contact lens was within 7 and 21 days. Vision was improved. Numbers of eyes with corneal haze grading as 1, 2 and 3 were 2, 7 and 5 in each group respectively. No other complications were observed except thinning of cornea and keratectasia in 1 eye. Enucleation was performed in 1 eye that had corneal self-resolution and perforation combined with retinal detachment. Conclusions In this observational study, early lamellar keratectomy combined with multilayer amniotic membrane transplantation and bandage contact lens, systemic antiviral and topical corticosteroid therapy to eyes with necrotizing HSK may preserve the intact eye and effective vision, in addition it avoids corneal transplantation at all or at least delayed corneal transplantation during the acute phase of inflammation. Key words: Lamellar keratectomy; Bandage contact lens; Amniotic membrane transplantation; HSK