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COMPARISON BETWEEN CORNEAL AND AMNIOTIC MEMBRANE GRAFTS TO RESTORE CORNEAL THINNING

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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 - PowerPoint PPT Presentation
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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
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Page 1: COMPARISON BETWEEN CORNEAL AND AMNIOTIC MEMBRANE GRAFTS TO RESTORE CORNEAL THINNING

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

Page 2: COMPARISON BETWEEN CORNEAL AND AMNIOTIC MEMBRANE GRAFTS TO RESTORE CORNEAL THINNING

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)

Page 3: COMPARISON BETWEEN CORNEAL AND AMNIOTIC MEMBRANE GRAFTS TO RESTORE CORNEAL THINNING

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.

Page 4: COMPARISON BETWEEN CORNEAL AND AMNIOTIC MEMBRANE GRAFTS TO RESTORE CORNEAL THINNING

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)

Page 5: COMPARISON BETWEEN CORNEAL AND AMNIOTIC MEMBRANE GRAFTS TO RESTORE CORNEAL THINNING

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

Page 6: COMPARISON BETWEEN CORNEAL AND AMNIOTIC MEMBRANE GRAFTS TO RESTORE CORNEAL THINNING

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;

Page 7: COMPARISON BETWEEN CORNEAL AND AMNIOTIC MEMBRANE GRAFTS TO RESTORE CORNEAL THINNING

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

Page 8: COMPARISON BETWEEN CORNEAL AND AMNIOTIC MEMBRANE GRAFTS TO RESTORE CORNEAL THINNING

Pre operative of corneal thinning

7th day pos op of amniotic

membrane transplantation

6 months pos op of amniotic

membrane transplantation

Page 9: COMPARISON BETWEEN CORNEAL AND AMNIOTIC MEMBRANE GRAFTS TO RESTORE CORNEAL THINNING

Pre operative of corneal thinning

7th day pos op of corneal graft

6 months pos op of corneal graft

Page 10: COMPARISON BETWEEN CORNEAL AND AMNIOTIC MEMBRANE GRAFTS TO RESTORE CORNEAL THINNING

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

Page 11: COMPARISON BETWEEN CORNEAL AND AMNIOTIC MEMBRANE GRAFTS TO RESTORE CORNEAL THINNING

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

Page 12: COMPARISON BETWEEN CORNEAL AND AMNIOTIC MEMBRANE GRAFTS TO RESTORE CORNEAL THINNING

CONCLUSIONCONCLUSION

The results suggest that both AM and corneal grafts are good options to be used for restoring corneal defects with thinning.


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