Self-Retained Amniotic Membrane for Post-PRK Keratitis
Narrative Responses:
Purpose
To demonstrate the efficacy of self-retained cryopreserved amniotic membrane in treating diffuse keratitis.
Methods
A 40 year-old male developed severe painful loss of vision in his right eye 2 days following bilateral uneventful PRK for myopia. Despite negative culture, his physician suspected infectious keratitis and tried several fortified topical antibiotics. Two weeks later, his condition got worse and was referred to us. Examination revealed severe photophobia, visual acuity of LP (OD), diffuse keratitis, total corneal ulcer, stomal haze and hypopyon. After stopping the antibiotics for 24 hours, repeated culture came out negative. We then placed a self-retained amniotic membrane (ProKera®,Bio-Tissue, Inc., Miami, Florida, USA) and added topical preservative free steroids.
Results
Two days after treatment, ocular pain was decreased, inflammation was markedly reduced and corneal epithelialization was initiated. On the second week, the amniotic membrane was dissolved and a second Prokera was used. Complete epithelialization occurred 2 weeks later and visual acuity improved to 20/40. Prokera was removed and the steroids eye drops were tapered off.
Conclusion
Placement of self-retained cryopreserved amniotic membrane appears effective in treating diffuse keratitis. Early intervention is recommended to control inflammation, prevent further damage, restore corneal integrity and reduce the potential of scarring.