Posters

Iatrogenic ‘bullae’ following amniotic membrane inlay and overlay for bullous keratopathy

Poster Details

First Author: S.Koay UK

Co Author(s):    L. De Benito-Llopis                    

Abstract Details

Purpose:

To describe two cases of amniotic membrane transplantation (AMT) in patients with bullous keratopathy and poor visual potential. In both cases there was poor adhesion of amniotic membrane graft to the cornea, leading to the formation of iatrogenic ‘bullae’.

Setting:

Department of Cornea & External Diseases, Moorfields Eye Hospital, United Kingdom.

Methods:

Both patients had bullous keratopathy with poor visual potential, and were experiencing pain and discomfort. AMT was therefore performed, with a combined inlay and overlay technique. Host corneal epithelial was debrided with partial trephination to approximately 120 microns, and a 360 degree peripheral pocket formed. The edges of inlay amniotic membrane (AM) were placed into the peripheral pocket and secured to host cornea with (epithelium side up) with fibrin glue. The overlay AM (epithelium side down) was then sutured to the sclera with a continuous 10/0 vicryl suture. A bandage contact lens was placed over this.

Results:

Pain resolved in both cases. However, both had poor integration of inlay AM to host cornea, with formation of bullae. One bullae was shallow and did not appear to be causing problems. However, the other had a large bullae which necessitated puncturing. 2 months later, the bullae reformed but was more shallow, and is currently being monitored. Our unit has recently switched from cryopreserved AM to freeze dried AM. As these iatrogenic ‘bullae’ have only been a recent issue, it is possible that freeze dried AM is less effective as a AMT inlay.

Conclusions:

Whilst AMT inlay and overlay are useful to alleviate symptoms of pain in bullous keratopathy, there is a possibility of poor adhesion of the inlay layer with freeze dried AM. This can result in the formation of bullae, which may need to be punctured if they are too large. Both our patients currently have shallow bullae which are being monitored. Further cases will need to be performed to see if this continues to be an issue with freeze dried AM.

Financial Disclosure:

None