COMPARISON BETWEEN CORNEAL AND AMNIOTIC MEMBRANE
GRAFTS TO RESTORE CORNEAL THINNING Charles C. Farias,
Rossen M. Hazarbassanov, Luiz A. Vieira, Luciene B. Souza, Norma Allemann, José A. P. Gomes
Corneal and External Disease
Departament of Ophthalmology
Federal University of São Paulo - Brazil
The authors have no financial interest in the subject matter of this poster
P 733
PURPOSETo evaluate the use of preserved corneal and multilayer AM graft for the surgical repair of corneal thinning.
PARTICIPANTSPARTICIPANTS• Prospective, comparative, interventional and controlled study• 19 eyes of 19 patients• The mean age was 61,05±SD (45-80) • 09 were female and 10 male • All patients were operated by one surgeon (CCF) • Surgical procedure was randomized:
1. Corneal graft (10 eyes)2. AM graft (9 eyes)
METHODSMETHODS
• Complete eye examination:Complete eye examination: BCVA, Biomicroscopy, Tonometry, Fundoscopy, UBM, USG
• Surgical Technique:Surgical Technique: superficial keratectomy, regularity of the thinning edge with trephine, ressection of excessive tissue, pocket formation, preparation of tissue donor, 10-0 nylon suture
• PosoperativePosoperative– Topical prednisolone acetate 1%– Topical ofloxacine 0,3%– All suture were removed within 3 months
• Follow upFollow up
– One day, 7, 15, 30, 90 and 180 days after surgery.
RESULTSRESULTS
Tim
e of
epi
thel
izat
ion
(day
s)
Galilei max (micron)
Thi
ckne
ss (
6M
)
Galilei max (micron)
Tim
e of
epi
thel
izat
ion
(day
s)
Galilei max (micron)
Mann-Whitney Test; p=0,216
GroupAM
Group
Mann-Whitney Test, p=0,165
AMT
hick
ness
(6M
)
Galilei max (micron)
Tim
e of
epi
thel
izat
ion
(day
s)
Galilei max (micron)
AM CorneaAMCorneaTh
ickn
ess (
6m
)
Tim
e o
f ep
ith
eliza
tion
( 6
m)
RESULTSRESULTS
Mann-Whitney Test; p=0,457
BCV
A (
LogM
ar)
6 M
Galilei max (micron)
AM
BC
VA
(Log
Mar)
6m
BC
VA
(Log
Mar)
6m
Amniotic membrane graft group
N= Sex/age Assoc Disease
Finding preop
UBM pre Size V/H Reepithelization (days)
Finding postop
UBM 6 Months(m
m)
Success/Failure
1 M/60 HBP Corneal Thining
0,15 4/2 90 Stable ocular surface
0,61 Success
2 M/80 none Corneal Thining
0,31 2/1,5 28 Persistent corneal thinning
0,29 Failure
3 M/45 none Corneal Thining
0,29 2/3 8 Stable ocular surface
0,39 Success
4 M/64 none Corneal Thining
0,24 2/2 21 Stable ocular surface
0,48 Success
5 F/47 none Corneal Thining
0,37 5/4 15 Stable ocular surface
1,12 Success
6 M/52 none Corneal Thining
0,17 4/1,5 15 Stable ocular surface
0,64 Success
7 F/52 none Corneal Thining
0,15 1,5/3 15 Stable ocular surface
0,35 Success
8F/56
HBP, DM Corneal Thining
0,26 3/4 21 Stable ocular surface
0,48 Success
9 F/66 DYSL Corneal Thining
0,23 5/2,5 40 Stable ocular surface
0,6 Success
DM-Diabetes Mellitus; HBP- high blood pressure; DYSL- Dyslipidemia;
Corneal graft groupN Sex/age Assoc
DiseaseFinding preop
UBM pre(mm)
Size V/H Reepithelization (days)
Finding postop
UBM 6 Months(m
m)
Success/Failure
1 F/72 HBP, DYSL Corneal Thining
0,23 5/2 8 Stable ocular surface
1 Success
2 F/73 HBP, CARD Corneal Thining
0,35 4/2 15 Stable ocular surface
0,79 Success
3 F/57 DM, CARD Corneal Thining
0,224 7/2 21 Stable ocular surface
0,93 Success
4 F/36 None Corneal Thining
0,26 2/3 15 Stable ocular surface
0,67 Success
5 M/73 CARD Corneal Thining
0,27 3/2 30 Stable ocular surface
0,67 Success
6 M/72 HBP, DM Corneal Thining
0,19 4,5/3,5 8 Stable ocular surface
0,85 Success
7 F/83 None Corneal Thining
0,29 3/1 15 Stable ocular surface
0,5 Success
8 M/65 HBP Corneal Thining
0,27 3/6 15 Stable ocular surface
1,08 Success
9 M/40 None Corneal Thining
0,25 4/2 15 Stable ocular surface
0,7 Success
10 M/67 HBP Corneal Thining
0,22 2/3 21 Stable ocular surface
0,52 Success
DM-Diabetes Mellitus; HBP- high blood pressure; DYSL- Dyslipidemia; CARD-Cardiopathies
Pre operative of corneal thinning
7th day pos op of amniotic
membrane transplantation
6 months pos op of amniotic
membrane transplantation
Pre operative of corneal thinning
7th day pos op of corneal graft
6 months pos op of corneal graft
RESULTSRESULTS
• All eyes that received corneal grafts (10/10) presented stability of the ocular surface with rapid re-epithelialization and restauration of the corneal thickness
• Eyes that received the AM grafts also presented stability of the OS with re-epithelialization (8/9), but the transplanted tissue absorbed on average after 30 d of follow up (p<0.05)– 1/9 partial AM re-absortion– 8/9 total AM re-absortion
• A persistent epithelial defect was noted in in only two eyes
DISCUSSIONDISCUSSION
• In the present study we observed– a marked reduction in ocular inflammation
after AMT– Corneal stroma thickness was restored in
88,88% and 100% of cases after AMT and corneal graft, respectively
– rapid epithelial wound healing and long-term stability of the corneal surface
CONCLUSIONCONCLUSION
The results suggest that both AM and corneal grafts are good options to be used for restoring corneal defects with thinning.