Comparative Study of Amniotic Membrane Fixation Methods in the Treatment of Persistent Corneal Epithelial Defects

Purpose: to evaluate and compare the effectiveness of suture and combined methods of amniotic membrane fixation in surgical treatment of corneal persistent epithelial defects. Materials and methods: 50 patients (54 eyes) were included in the research. Etiology of corneal persistent epithelial defects: corneal traumas and burns, high-risk keratoplasty, repeated vitreoretinal interventions with corneal de-epithelization. Two groups were formed: the main group (combined method of amnioplasty with sutures and two-component autofibrin glue) and the control group (suture amnioplasty). In the course we studied: the area of corneal erosion before and after surgery, duration of surgery, amnion lysis time, OCT-characteristics of amnion position on the ocular surface, qualitative and temporal characteristics of surgery according to the survey among the surgeons.

Results. In the preoperative period, the average area of the epithelial defect in the main group was 27.5 (19.3; 32.8) mm², in the control group — 32.6 (20.5; 36.5) mm². The average operation time in the main group was 19 (17; 21) min and in the control group was 30 (25; 35) min. The average period of amnion lysis in the main group — 10 (9; 12) days, in the control group — 7 (7; 9) days. The size of the erosion area in the main group at the end of treatment was 4.3 (2.4; 5.3) mm², in the control group — 9.7 (7.5; 12.8) mm². Deformation of the amnion profile according to OCT data was observed in the control group — 40 % of cases. Detachment of the amniotic membrane from the cornea in the main group was in 15.3 % of cases, in the control group — in 53.3 %.

Conclusion. The combined method of amnion fixation to the ocular surface in the treatment of corneal persistent epithelial defects developed by us is proved to be significantly more effective and reliable. 

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