Dehydrated Amniotic Membrane as Adjunctive Therapy for Recurrent Immunological Corneal Ulcer: A Case Report
A. Denial *
Department of Adult Ophthalmology, 20 August 1953 Hospital, Ibn Rochd University Hospital Center, Casablanca, Morocco.
Y. Tahri
Department of Adult Ophthalmology, 20 August 1953 Hospital, Ibn Rochd University Hospital Center, Casablanca, Morocco.
H. Sokrat
Department of Adult Ophthalmology, 20 August 1953 Hospital, Ibn Rochd University Hospital Center, Casablanca, Morocco.
A. Sandali
Department of Adult Ophthalmology, 20 August 1953 Hospital, Ibn Rochd University Hospital Center, Casablanca, Morocco.
Y. Hidan
Department of Adult Ophthalmology, 20 August 1953 Hospital, Ibn Rochd University Hospital Center, Casablanca, Morocco.
M.R. Bentouhami
Department of Adult Ophthalmology, 20 August 1953 Hospital, Ibn Rochd University Hospital Center, Casablanca, Morocco.
A. Hammouche
Department of Adult Ophthalmology, 20 August 1953 Hospital, Ibn Rochd University Hospital Center, Casablanca, Morocco.
A. Mchachi
Department of Adult Ophthalmology, 20 August 1953 Hospital, Ibn Rochd University Hospital Center, Casablanca, Morocco.
L. Benhmidoune
Department of Adult Ophthalmology, 20 August 1953 Hospital, Ibn Rochd University Hospital Center, Casablanca, Morocco.
R. Rachid
Department of Adult Ophthalmology, 20 August 1953 Hospital, Ibn Rochd University Hospital Center, Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Amniotic membrane transplantation has become an established therapeutic approach for ocular surface reconstruction. It is commonly used in persistent epithelial defects, corneal ulcers, chemical burns, and after pterygium surgery. Dehydrated amniotic membrane (DAM) is a processed form of human amniotic tissue that can be stored at room temperature and easily applied in outpatient settings. DAM provides anti-inflammatory, anti-angiogenic, and epithelial regenerative properties. The aim of this report is to highlight the therapeutic role of dehydrated amniotic membrane in the management of recurrent immunological corneal ulcers.
Case Presentation: We report the case of a 68-year-old woman with dermatomyositis treated with systemic corticosteroids, associated with Raynaud’s phenomenon and livedo. She presented with a painful red left eye and decreased visual acuity. Five months earlier, the patient had developed a corneal ulcer in the same eye that healed slowly after intensive medical therapy.
On admission, visual acuity was limited to hand motion perception. Slit-lamp examination revealed a deep marginal corneal ulcer measuring approximately 10 × 5 mm with positive fluorescein staining. Corneal sensitivity was preserved and the Schirmer test measured 20 mm, suggesting reflex tearing. The anterior chamber was well formed and a total white cataract prevented fundus visualization. The contralateral eye showed mild ocular surface disease with diffuse superficial punctate keratitis, tear break-up time of 5 seconds, and Schirmer test of 9 mm.
Initial management included preservative-free lubricating agents and antibiotic prophylaxis. Due to the absence of clinical improvement, a dehydrated amniotic membrane was applied in order to promote corneal epithelial healing.
Complete epithelial healing was observed within 10 days after membrane placement.
Conclusion: Dehydrated amniotic membrane represents a safe and effective adjunctive therapy for immunological corneal ulcers, particularly in settings where access to cryopreserved amniotic membrane is limited.
Keywords: Amniotic membrane transplantation, dehydrated amniotic membrane, immunological corneal ulcer, ocular surface reconstruction, autoimmune keratitis