Lesion debridement combined with amniotic membrane transplantation treating persistent fungal keratitis

Objective To investigate the therapeutic effect and complication of amniotic membrane transplantation (AMT) combined with debridement in persistent fungal keratitis. Methods Diagnosis of fungal keratitis was confirmed by corneal scraping examination or fungal cultures in 16eyes of 16 patients.The indications to perform AMT combined with debridement were to promote reepithelialization in non-healing ulcers.Antifungal agents were administered throughout the whole course of hospitalization.Repeated cultures were performed immediately before AMT combined debridement.The main outcome measurements were epithelial healing rate,necessity therapeutic penetrating keratoplasty (TPK),and persistence of infection. Results During follow-up time ranged from 3 to 6 months,AMT combined debridement was performed during the active phase of the keratitis (corneal scraping examination revealed fungal presence in smears or in vivo confocal microscopy) in 11 patients (68.8％),and during non-active phase (corneal scraping or in vivo confocal microscopy negative) in 5 patients (31.2％).Fourteen patients were performed AMT combined debridement only single time,2 eyes two times.Treatment failure requiring TPK was experienced in 2 patients (12.5％).Complete epithelializatiion was observed in all patients.The mean reepthelialization time was 13.21±6.35 days.The final visual acuity improved in all patients. Conclusions AMT combined debridement is effective in promoting epithelialization and curing in persistent fungal keratitis,and there is no severe complication observed during the follow-up.The risk of recurrent infection necessitates continue antifungal treatment and patients monitoring. Key words: Fungal;  Keratitis;  Amniotic membrane