Abstract

SO.06.06

Amniotic membrane transplantation in active herpetic keratitis: Successful anti-inflammatory treatment before elective penetrating keratoplasty

Spelsberg H., Reichelt J.
Department of Ophthalmology, Universitätsklinikum Düsseldorf

Objective: In active herpetic keratitis, treatment with systemic and topical aciclovir together with low-dose steroids is succesful since few decades. However, in cases with severe herpetic ulcer and melting inflammation, emergency penetrating keratoplasty is necessary, which carries high risk for recurrent herpetic keratitis and rejection. The anti-inflammatory potential of amniotic membrane has been proven in other corneal inflammatory pathologies. This retrospective study was conducted to analyse the effect of amniotic membrane in herpetic keratitis.
Methods: Twelve eyes of 12 patients with clinically clear highly active herpetic ulcer without healing despite aciclovir were treated with amniotic membrane transplantation. Ten of 12 eyes showed positive PCR testing for HSV 1 (one other negative, one other not done). For surgery, debridement of the ulcer’s margins and ground of the ulcer was done with steam heated cauterisation. Afterwards, amniotic membrane was made to cover the defect and fixed with single sutures. Peri- and postoperatively, patients were treated with systemic aciclovir (4000 mg one week, 2000mg 2 weeks) and gentamicin ointment topically.
Results: After 25 days in mean, nine of 12 patients (75%) experienced an intact epithelial corneal surface together with a clinically clear reduction of the inflammation. Three other patients did not recover and were then treated with emergency penetrating keratoplasty. As foreseen, visual acuity did not improve after amniotic membrane transplantation.
Conclusions: The known anti-inflammatory potential of amniotic membrane causes a reduction of the inflammatory process in herpetic ulcer, if the transplantation is performed timely. An otherwise necessary emergency keratoplasty can be avoided. This gives the opportunity to plan an elective penetrating keratoplasty with better prognosis.

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