Abstract
Purpose
To evaluate the use of surgical treatment with amniotic membrane for long-term atopic keratoconjunctivitis. Damaged corneas were repaired with various techniques: amniotic membrane transplantations, amniotic membrane coverings, amniotic membrane fillings (AMFs), and amniotic membrane inlay fillings, the latter of which were combined with glycerol-preserved corneal transplants.
Methods
This retrospective study was conducted on 37 eyes belonging to 37 patients with atopic keratoconjunctivitis. Thirty-two patients were classified into four groups according to surgical technique. Five patients undergoing medical management served as controls. Surgical outcome was measured by recovery time and long-term visual improvement.
Results
In all surgical eyes, integrity of ocular tissues was effectively restored and symptoms were reduced at 24.4±13 days post recovery. Mean best-corrected visual acuity improved from 0.6±0.2 to 0.198±0.16 logarithm of the minimum angle of resolution (P<0.001). There were no intraoperative or postoperative complications, with the exception of two recurring cases, both controlled by medication. Recovery time of the control groups lasted 52±16 days. In controls, mean best-corrected visual acuity improved from 0.74±0.15 to 0.54±0.29 logarithm of the minimum angle of resolution (P≤0.05). The vision improvement has significant difference for surgical treatment vs medical. (Mann–Whitney U-test, U=119, P<0.05, one tailed).Vision improvements remained stable during a mean follow-up period of 21.7±3.8 months.
Conclusion
Patients suffering from severe chronic atopic keratoconjunctivitis and its complications can benefit from suitable surgical treatments: transplants, covers, fillings, or corneal graft surgeries supplemented with AMFs.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Rachdan D, Anijeet DR, Shah S . Atopic keratoconjunctivitis: present day diagnosis. Br J Ophthalmol 2012; 96 (11): 1361–1362.
Sakarya Y, Sakarya R . Treatment of refractory atopic blepharoconjunctivitis with topical tacrolimus 0.03% dermatologic ointment. J Ocul Pharmacol Ther 2012; 28 (1): 94–96.
Kruse FE, Cursiefen C . Surgery of the cornea: corneal, limbal stem cell and amniotic membrane transplantation. Dev Ophthalmol 2008; 41: 159–170.
Vanathi M, Sharma N, Titiyal JS, Tandon R, Vajpayee RB . Tectonic grafts for corneal thinning and perforations. Cornea 2002; 21 (8): 792–797.
Rahman I, Carley F, Hillarby C, Brahma A, Tullo AB . Penetrating keratoplasty: indications, outcomes, and complications. Eye (Lond) 2009; 23 (6): 1288–1294.
Kim BH . Surgical treatment of necrotic scleral calcification using combined conjunctival autografting and an amniotic membrane inlay filling technique. Eye (Lond) 2011; 25 (11): 1484–1490.
Guglielmetti S, Dart JK, Calder V . Atopic keratoconjunctivitis and atopic dermatitis. Curr Opin Allergy Clin Immunol 2010; 10 (5): 478–485.
Prabhasawat P, Barton K, Burkett G, Tseng SC . Comparison of conjunctival autografts, amniotic membrane grafts, and primary closure for pterygium excision. Ophthalmology 1997; 104 (6): 974–985.
Li J, Yu L, Deng Z, Wang L, Sun L, Ma H et al. Deep anterior lamellar keratoplasty using acellular corneal tissue for prevention of allograft rejection in high-risk corneas. Am J Ophthalmol 2011; 152 (5): 762–770.e3.
Seitz B, Das S, Sauer R, Mena D, Hofmann-Rummelt C . Amniotic membrane transplantation for persistent corneal epithelial defects in eyes after penetrating keratoplasty. Eye (Lond) 2009; 23 (4): 840–848.
Takano Y, Fukagawa K, Miyake-Kashima M, Tanaka M, Asano-Kato N, Dogru M et al. Dramatic healing of an allergic corneal ulcer persistent for 6 months by amniotic membrane patching in a patient with atopic keratoconjunctivitis: a case report. Cornea 2004; 23 (7): 723–725.
Fukuda K, Yamada N, Nishida T . Case report of restoration of the corneal epithelium in a patient with atopic keratoconjunctivitis resulting in amelioration of ocular allergic inflammation. Allergol Int 2010; 59 (3): 309–312.
Rodriguez-Ares MT, Tourino R, Lopez-Valladares MJ, Gude F . Multilayer amniotic membrane transplantation in the treatment of corneal perforations. Cornea 2004; 23 (6): 577–583.
Prabhasawat P, Tesavibul N, Komolsuradej W . Single and multilayer amniotic membrane transplantation for persistent corneal epithelial defect with and without stromal thinning and perforation. Br J Ophthalmol 2001; 85 (12): 1455–1463.
Jhanji V, Young AL, Mehta JS, Sharma N, Agarwal T, Vajpayee RB . Management of corneal perforation. Surv Ophthalmol 2011; 56 (6): 522–538.
Power WJ, Tugal-Tutkun I, Foster CS . Long-term follow-up of patients with atopic keratoconjunctivitis. Ophthalmology 1998; 105 (4): 637–642.
Ghoraishi M, Akova YA, Tugal-Tutkun I, Foster CS . Penetrating keratoplasty in atopic keratoconjunctivitis. Cornea 1995; 14 (6): 610–613.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Yang, J., Yang, Fh., Peng, CH. et al. Surgical treatment of 32 cases of long-term atopic keratoconjunctivitis using the amniotic membrane. Eye 27, 1254–1262 (2013). https://doi.org/10.1038/eye.2013.161
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/eye.2013.161
