Amniotic membrane transplantation for pseudomonal keratitis with impending perforation.

BACKGROUND: To determine whether amniotic membrane transplantation (AMT) can be used as adjunctive therapy to promote wound healing and prevent perforation in bacterial keratitis caused by Pseudomonas aeruginosa. METHODS: We report on 6 eyes from 6 patients with bacterial keratitis caused by Pseudomonas aeruginosa associated with prominent stromal melting and extensive stromal loss. AMT was performed after treatment with fortified antibiotics for at least 1 week. The mean follow-up period was 12.8+/-2.5 months. RESULTS: The lesion became sterile in all but 1 case for which AMT was performed. Rapid reepithelialization and decreased inflammation was observed in 5 cases, with complete reepithelialization occurred at 9.4+/-2.1 days postoperatively. The amniotic membrane dissolved in the remaining case with active, extensive corneal infection and persistent epithelial defect; this case finally received evisceration due to intractable glaucoma. In all other cases, after AMT treatment, lesions did not extend, stromal loss was limited, and considerable stromal thickness was preserved. CONCLUSION: AMT may be considered an alternative method for treating pseudomonal keratitis, especially when stromal melting and loss are extensive, and the infection has been controlled.