Multilayer amniotic membrane transplantation in the treatment of corneal perforations

Cornea. 2004 Aug;23(6):577-83. doi: 10.1097/01.ico.0000121709.58571.12.


Purpose: To determine if multilayer amniotic membrane transplantation (AMT) is useful in the treatment of corneal perforations, and in particular to assess to what extent efficacy is affected by perforation size.

Methods: Fifteen patients (15 eyes) with corneal perforations of different sizes were divided into 3 groups: group A (microperforation, 6 eyes), group B (0.5-1.5 mm, 4 eyes), and group C (>1.5 mm, 5 eyes). The corneal perforation was caused by autoimmunity-related ulcer (3 eyes), neurotrophic ulcer (9 eyes), infectious keratitis (1 eye), or postkeratoplasty ulcer (2 eyes). Two layers of AM (for microperforations) or 3-4 layers (for the other groups) were trimmed to the size of the ulcer and sutured in place with interrupted 10-0 nylon sutures. In all cases, a bandage contact lens was then applied.

Results: Mean epithelialization time was 3.7 weeks (range 2-6). Mean time to recovery of corneal stroma thickness was 10.1 weeks (range 7-15). In all cases, ocular inflammation subsided within 2-5 weeks. The treatment was judged successful in 73% (11/15) of eyes. Three of the 4 unsuccessful treatments were of perforations 3 mm or more in diameter; of the 5 eyes with perforations of more than 1.5 mm in diameter, only 2 were treated successfully.

Conclusions: These results suggest that multilayer AMT is effective for treating corneal perforations with diameter less than 1.5 mm. The technique may be a good alternative to penetrating keratoplasty, especially in acute cases in which graft rejection risk is high.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Amnion / transplantation*
  • Biological Dressings*
  • Cornea / pathology
  • Cornea / surgery*
  • Corneal Ulcer / pathology
  • Corneal Ulcer / surgery*
  • Epithelium, Corneal / pathology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Rupture, Spontaneous
  • Wound Healing