Microbial Keratitis following Self-Retained Cryopreserved Amniotic Membrane

Area of Science:

• Ophthalmology
• Microbiology
• Regenerative Medicine

Background:

• Neurotrophic ulcers and herpetic epithelial keratitis can lead to severe ocular surface disease.
• Cryopreserved amniotic membranes are used to promote ocular surface healing.
• PROKERA® SLIM is a specific type of self-retained amniotic membrane device.

Observation:

• A patient with a history of herpetic epithelial keratitis developed a neurotrophic ulcer.
• PROKERA® SLIM was implanted to treat the ocular surface condition.
• The patient subsequently developed a severe mixed fungal and bacterial microbial keratitis.

Findings:

• Despite aggressive topical and systemic antimicrobial therapy, the microbial keratitis was recalcitrant.
• The severe infection led to the eventual evisceration of the patient's eye.
• This case suggests a potential association between PROKERA implantation and severe microbial keratitis.

Implications:

• Ophthalmologists should exercise caution when considering PROKERA implantation, particularly in patients with compromised corneas or prior herpetic infections.
• The risk of severe, sight-threatening microbial keratitis should be weighed against the potential benefits of amniotic membrane use.
• Further investigation into the potential association between amniotic membrane devices and severe microbial keratitis is warranted, especially in high-risk patients.