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Freeze-dried amniotic membrane graft with a spongy layer in bilateral peripheral ulcerative keratitis: a case report
Clara Bertret1, Loïc Leveziel1, Juliette Knoeri2
1Sorbonne Université, GRC n°32, Transplantation et Thérapies Innovantes de la Cornée, AP- HP, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, 28 rue de Charenton, Paris, F-75012, France.
Background:
Peripheral ulcerative keratitis (PUK) is a group of inflammatory corneal ulcers with stromal thinning and peripheral localization. Amniotic membranes (AM) are used for their anti-inflammatory and healing properties. A freeze-drying process now allows maintaining the AM viable for a long time at room temperature without altering its physical, biological, and morphologic characteristics. The effectiveness of spongy freeze-dried amniotic membrane (FD-AM) graft with multimodal imaging in the management of severe corneal thinning PUK has not been reported.
Case Presentation:
A 67-year-old Caribbean man histologically diagnosed with ulcerative colitis, was referred to our tertiary eye care center for a deep nasal juxtalimbal ulcer of the left eye. He was treated with topical steroids and antibiotics, methylprednisolone pulses, and oral prednisone. Due to continuous stromal thinning with 100 μm of residual corneal thickness, the decision was made to perform surgery. Conjunctival resection, inlay and overlay spongy FD-AM (Visio Amtrix® S, Tissue Bank of France, FR) were performed to preserve globe integrity. Despite tapering off oral steroids, PUK developed in the fellow eye on the 2 months follow-up. Treatment with human monoclonal antibody against tumor necrosis factor-alpha was initiated to control the active underlying inflammation. Six months following surgery, the ulcer was healed and corneal thickness in front of the former ulceration was measured at 525 μm on anterior segment-optical coherence tomography. Confocal microscopy confirmed the integration of the amniotic membrane between the corneal epithelium and the anterior stroma.
Conclusion:
Transplantation of FD-AM with a spongy layer was associated with restoration of normal corneal thickness in the PUK area. It seems to be a safe, effective, and easily accessible solution for the surgical management of PUK with impending perforation.
Insights
Spongy freeze-dried amniotic membrane (FD-AM) transplantation successfully treated severe peripheral ulcerative keratitis (PUK) with corneal thinning. This safe and effective surgical option restored corneal thickness and preserved globe integrity in a PUK patient.
Area of Science:
- Ophthalmology
- Regenerative Medicine
Background:
- Peripheral ulcerative keratitis (PUK) involves inflammatory corneal ulcers with peripheral stromal thinning.
- Amniotic membranes (AM) possess anti-inflammatory and healing properties.
- Freeze-drying (FD) preserves AM viability at room temperature without altering characteristics.
Observation:
- A patient with ulcerative colitis presented with severe PUK and corneal thinning (100 μm).
- Surgical management involved spongy freeze-dried amniotic membrane (FD-AM) graft (inlay/overlay).
- The fellow eye developed PUK, treated with anti-TNF-alpha therapy.
Findings:
- FD-AM transplantation restored corneal thickness to 525 μm within 6 months.
- Anterior segment-optical coherence tomography and confocal microscopy confirmed AM integration.
- The PUK ulcer healed, preserving globe integrity.
Implications:
- Spongy FD-AM is a safe and effective surgical option for PUK with impending perforation.
- This approach offers a readily accessible solution for managing severe corneal thinning.
- Multimodal imaging aids in assessing FD-AM graft success in PUK management.
