Amniotic membrane transplantation in severe bacterial keratitis

Cornea. 2007 Jan;26(1):27-33. doi: 10.1097/ICO.0b013e31802b28df.


Purpose: To determine whether a combination of early amniotic membrane transplantation (AMT) and early topical corticosteroid treatment could be a safe adjuvant therapy during antibacterial treatment in severe bacterial keratitis (BK) for relieving pain, avoiding iatrogenic epithelial toxicity, and allowing earlier use of topical steroids.

Methods: In a prospective noncomparative case series, 12 patients with severe microscopically-proven BK were treated with immediate maximal topical antibiotics followed by AMT at 48 hours (single-layer epithelial side-down or multilayer epithelial side-up), plus topical steroid treatment at 72 hours. Pain relief (NRS-11 numeric rating pain scale) and the corneal epithelium healing were measured.

Results: The follow-up rate was 7.5 person-months, with AMT performed once in 2 patients and twice in 10 patients with BK caused by Pseudomonas aeruginosa (5), Klebsiella pneumoniae (1), Moraxella cattharalis (1), Staphylococcus aureus (1), Staphylococcus epidermidis (2), or Streptococcus pneumoniae (1). A significant decrease in the pain score was noted from the admission day (median, 8; range, 7-10) to shortly after AMT (at day 3: median, 2; range, 1-3). Epithelial healing was achieved between 8 and 45 days (mean, 25.5 +/- 9.7 days). Neither perforation nor neovascularization was observed.

Conclusions: Early AMT combined with topical corticosteroid in severe BK provides immediate pain relief and allows epithelial healing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Amikacin / therapeutic use
  • Amnion / transplantation*
  • Anti-Bacterial Agents / therapeutic use
  • Ceftazidime / therapeutic use
  • Combined Modality Therapy
  • Corneal Ulcer / drug therapy
  • Corneal Ulcer / microbiology*
  • Corneal Ulcer / surgery*
  • Drug Therapy, Combination
  • Epithelium, Corneal / physiology
  • Eye Infections, Bacterial / drug therapy
  • Eye Infections, Bacterial / microbiology
  • Eye Infections, Bacterial / surgery*
  • Female
  • Glucocorticoids / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Pain Measurement
  • Prospective Studies
  • Vancomycin / therapeutic use
  • Wound Healing


  • Anti-Bacterial Agents
  • Glucocorticoids
  • Vancomycin
  • Amikacin
  • Ceftazidime