Amniotic membrane transplantation in the management of shield ulcers of vernal keratoconjunctivitis
Section snippets
Material and methods
A brief summary of the four cases is shown in Table 1. Two surgeons (MSS and VSS) operated on these cases. Human amniotic membrane was prepared and preserved by the standard method described.7 The human placenta was obtained shortly after elective cesarean delivery. Serologic tests were performed to exclude human immunodeficiency virus, hepatitis virus type B, hepatitis virus type C, and syphilis.
Under laminar air hood, the placenta was cleared of blood clots with sterile Earle’s balanced salt
Case 1
An 18-year-old male was first seen on March 9, 1990, when he was diagnosed with vernal conjunctivitis. He was on regular follow-up. In March 1996, he was diagnosed with steroid-induced glaucoma for which he underwent trabeculectomy in the right eye. He was using 2% cyclosporine eyedrops four times a day in both eyes since July 1999. On October 30, 1999, he was seen with acute onset of pain and redness in the left eye. The right cornea showed limbal thickening, superficial vascularization, and
Discussion
Corneal manifestations usually occur in severe forms of vernal keratoconjunctivitis and are seen in nearly 50% of patients with palpebral vernal keratoconjunctivitis.8 Superficial epithelial keratitis, consisting of punctate dull gray opacities, occurs in the upper half of the cornea. The points may eventually break to form a macroerosion with raised margins. The compacted layer of collected cellular debris and mucus forms the vernal plaque or shield ulcer. These ulcers are located superiorly
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Cited by (56)
Urgent unmet needs in the care of bacterial keratitis: An evidence-based synthesis
2023, Ocular SurfaceCitation Excerpt :These comprise viruses (notably, herpes simplex viruses 1 and 2, and varicella zoster virus), fungi (yeasts including Candida spp., and molds including Fusarium spp. and Aspergillus spp.), and parasites (such as Acanthamoeba and microsporidia). Noninfectious entities that may mimic BK include contact-lens associated stromal infiltration, which usually occurs peripherally and most frequently among users of extended-wear soft contact lenses [101–103]; peripheral ulcerative keratitis associated with systemic autoimmune disease, including rheumatoid arthritis, systemic lupus erythematosus, and the vasculidites [104–107]; atopy-associated infiltrative keratitis, for instance vernal and atopic keratoconjunctivitis) [108,109]; dermatologic conditions such as ocular rosacea and pemphigoid [110,111]; and Mooren's ulcer [112,113]. Sterile ulceration may also occur in the setting of corneal trauma, including thermal and chemical injury [114].
Management of corneal complications in vernal keratoconjunctivitis: A review
2021, Ocular SurfaceCitation Excerpt :Recurrence of shield ulcers has been reported in 14.5% of eyes, necessitating a repeat of the surgical procedure [18]. Amniotic membrane transplantation with surgical debridement is an effective procedure that results in healing of shield ulcers within 1–6 weeks [78,79]. This procedure can be considered in grade 2 and 3 shield ulcers that are refractory to superficial debridement combined with steroid therapy or if corticosteroids are contraindicated (e.g., steroid responders) [17,78].
Allergic and Immunologic Diseases of the Eye
2014, Middleton's Allergy: Principles and Practice: Eighth EditionSurgical management and immunohistochemical study of corneal plaques in vernal keratoconjunctivitis
2013, Journal of the Formosan Medical AssociationCitation Excerpt :The amniotic membrane patch served as a basement membrane that facilitates migration of epithelial cells, promotes adhesion of basal cells, and prevents epithelial apoptosis.8 AMT in combination with debridement had been reported to be effective in treating shield ulcer.24 However, in our case, early melting of the amniotic membrane was significant in severe ulcer due to profound inflammation.
Treatment of Allergic Eye Disease
2013, Ocular Surface Disease: Cornea, Conjunctiva and Tear FilmManagement, clinical outcomes, and complications of shield ulcers in vernal keratoconjunctivitis
2013, American Journal of OphthalmologyCitation Excerpt :There is definite evidence that debridement helps in rapid re-epithelialization of shield ulcers, but the role of AMT in the management of shield ulcers is less emphasized.15,16 Sridhar and associates showed the beneficial role of AMT in the management of grade 2 and grade 3 shield ulcers.17 The amniotic membrane reinforces adhesion of basal epithelial cells and facilitates epithelial migration.