Офтальмохирургия (Oct 2015)
LONG-TERM RESULTS OF INTRASTROMAL AMNIOTIC MEMBRANE IMPLANTATION IN TREATMENT OF PATIENTS WITH INDUCED ENDOTHELIAL EPITHELIAL DYSTROPHY OF CORNEA
Abstract
Purpose. To evaluate long-term results of intrastromal amniotic membrane implantation in patients with induced endothelial epithelial dystrophy (EED) of cornea. Material and methods. The clinical study included 50 patients (50 eyes) with a diagnosis of secondary corneal EED of the far-advanced stage. All patients underwent the surgery of intrastromal implantation of amniotic membrane (IIAM) in the cornea.Results. The obtained data in the course of the study showed a slight, statistically significant increase of visual acuity in the operated patients. On admission of patients the visual acuity averaged 0.01±0.005, 24 months after the IIAM – 0.03±0.01 (p<0.05). Postoperatively all 50 patients (50 eyes) had the completion of epithelialization, corneal syndrome relief. On the 9th day the epithelialization ended after the IIAM in 85% of patients (42 eyes), and the corneal syndrome were stopped in 75% (37 eyes). After the 12-month follow-up, 18% of patients (9 eyes) periodically had relapses corneal syndrome of varying severity (1-2 times per month). According to the pachymetry the corneal thickness 7 days after the IIAM was 744±32.15μm, 1 month – 716±31.77μm, 3 months – 681±32.84μm, 6 months – 650±35.18 μm. At 12 months the pachymetry indicators significantly decreased up to 628±34.03μm on average by 18% (140 microns; p<0.05). After the 24-month follow-up the mean indices were 600±25.12μm, decreased from the baseline by 24% (169 microns; p<0.05).Conclusions. 1. Intrastromal amniotic membrane implantation in patients with the far-advanced induced endothelial epithelial dystrophy of the cornea in the long-term postoperative period (24 months) leads to a decrease in thickness (average by 24%), an increase of the transparency of the cornea due to a reduction of the hydration degree in anterior layers of stroma and a partial pulping of amniotic membrane. Thereto a statistically significant increase of visual acuity on average by 0.02 (p<0.05). 2. Intrastromal implantation of amnion provides a stable clinical effect within 2 years in 80% of cases and may be the method of choice in the treatment of patients with far-advanced EED stage or alternative methods of surgical treatment of corneal pathologies, where the main aim is the relief of persistent corneal syndrome, it serves as a preparatory step to the penetrating keratoplasty.
