Comparative evaluation of Amniotic Membrane Transplantation with conventional medical treatment versus conventional medical treatment alone in Suppurative Keratitis

摘要

Background : To study the role of amniotic membrane transplantation in infective keratitis.Methods : A prospective, randomized study on two groups of 20 patients with infective keratitis was done. Group A : only conventional medical treatment. Group B: conventional medical treatment with amniotic membrane transplantation was done.Results The mean age of patients was 46.30 ± 19.23 years. At 1 week follow-up, the improvement in symptoms like pain, redness, photophobia, watering and discharge was present in 24%, 4%, 25%, 28% respectively in patients without AMT, whereas it was 48%, 26%, 55% and 48% respectively in patients with AMT. The improvement in signs like size of corneal ulcer and hypopyon was 10% and 13% in patients without AMT, whereas it was 35.2% and 54% respectively in patients with AMT. Conclusion : Amniotic membrane transplantation with conventional medical treatment in infective keratitis is more effective than medical treatment alone. Background: Infective keratitis caused by bacteria, fungi, viruses or parasites leads to permanent corneal opacity or persistent epithelial defect 1,2,3 which is potentially sight threatening ocular problem. The cornea being avascular, is particularly susceptible to infection and many patients have poor clinical outcome, if aggressive and appropriate therapy is not promptly initiated 1,2 . The primary objective of therapy for infectious keratitis is to eliminate infective organism, prevent tissue destruction (stromal keratolysis) and corneal structural alterations. Traditionally, the most effective treatment of infective keratitis is obtained by topical delivery of antimicrobials directly to the infected cornea 1 . Supplementation with systemic antimicrobial is required in some cases 8 .However, in cases of progressive ulceration, surgical intervention becomes a necessity 1 . The ophthalmic literature describes a multitude of surgical procedures for corneal reconstruction. Recently, preserved human amniotic membrane has emerged as a useful tool in the reconstruction of the damaged ocular surfaces 4,5 . Certain characteristics like anti-inflammatory, antiangiogenic, antiinfective, antifibroblastic activities make the amniotic membrane ideally suited to its application in ocular surface 4,5 .In 1995, Kim and Tseng 6 introduced the modern way of using amniotic membrane in its current form because of its action in facilitating epithelization and reducing stromal inflammation and scarring.All the characteristics of amniotic membrane e.g. anti-inflammatory, antiangiogenic, antiinfective and antifibroblastic are useful in corneal ulcer healing. Only few studies are available in which amniotic membrane transplantation was done for infectious corneal or corneoscleral ulcers 7,8 . We conducted this study to compare the efficacy of amniotic membrane transplantation in addition to conventional therapy vs conventional therapy alone in patients with infective keratitis. Materials & Methods This prospective, randomized study was conducted on 40 patients having infective keratitis who were randomly divided into two groups of 20 each. A written informed consent was taken from all the patients as per guidelines of Helsinki Declaration.Patients of group A received only conventional medical treatment while patients of group B received conventional medical treatment along with underwent preserved human amniotic membrane transplantation.Patients with typical viral ulcers on clinical evaluation, ulcer associated with autoimmune condition, atheromatous corneal ulcer, perforating corneal ulcer having size of more than 2mm and corneal ulcer with endophthalmitis were excluded from the study.Detailed history was taken followed by ocular examination in all the patients. Symptoms like pain, redness, photophobia, watering & discharge were recorded and graded. Grades of pain : Grade 0 ; no pain , Grade 1; occasional mild pain,Grade 2; constant mild pain, Grade 3; moderate to severe pain,Grade 4 ; constant severe pa