AMT for Traumatic or Neurotrophic Corneal Perforation/Laceration

              Intraoperative Images of AMT for Corneal Perforation
                
         Layers of AM secured                        Layer of AM sutured 
  with fibrin glue to fill the defect                 to cover the defect

If the perforation site is less than 2 mm in diameter, first form the anterior chamber with air or one drop of Healon through the perforation site. Trim the Amniotic membrane (AM) (AMNIOGRAFT® size 2.5 x 2.0 cm) into small pieces and place them in multiple layers to fill the defect. Once the defect is filled the layers of AM can be secured with fibrin glue or sutures.

To secure these layers of AM with fibrin glue, apply one drop of fibrinogen over the layers of AM filling the defect. Wait for several seconds to allow the fibrinogen to percolate through the AM before adding several drops of thrombin over it. Alternately, AM can be secured to the corneal surface using 10-O nylon sutures.

Afterwards, a larger piece of AM is placed with the stromal surface facing the cornea is sutured to the healthy stroma with 10-O nylon in either interrupted or running fashion (zig-zag or purse string) to make sure the top membrane acting as a permanent graft is tightly flattened as a patch graft. The knot does not have to be buried.

The remaining AM can be laid down to cover the cornea, limbus, and part of conjunctiva like a therapeutic bandage contact lens (orientation does not matter), and suture it in the same manner as described above. Alternatively, PROKERA™ can be inserted as an overlaid graft.

A sutured tarsorrhaphy is beneficial especially for eyes with a neurotrophic state.

If the perforation site is more than 2 mm in diameter, a tectonic graft will be needed to fill the defect.

Videos

Corneal Perforation Surgery Video: Surgical treatment for a corneal perforation using amniotic membrane transplantation utilizing fibrin glue and sutures OSREF Amniotic Membrane Transplantation for Corneal Perforation

Papers

Click here to view standard surgical supplies used for AMT.

Click here to view standard Post-operative care for AMT

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