A MODIFIED TECHNIQUE OF AMNIOTIC MEMBRANE TRANSPLANTATION FOR THE TREATMENT OF A CHALLENGING CASE OF INFECTED HERPETIC NEUROTROPHIC ULCER IN A PATIENT WITH ACTIVE OCULAR CICATRICIAL PEMPHIGOID

To present a modified technique of Amniotic Membrane transplantation in a patient with multiple ocular surface problems, where surgically induced inflammation must be kept to a minimum.

Tertiary corneal surgery unit of General Hospital of Athens “G.Gennimatas”.

A 52-year-old female patient presented with a persistent corneal ulcer in her right eye. Her history included ocular cicatricial pemphigoid (OCP), neurotrophic ulcer as a result of past herpetic keratitis and use of therapeutic contact lenses. Examination revealed bacterial superinfection of the neurotrophic ulcer, corneal thinning, inferior symblepharon and active OCP, which were initially treated with a combination of topical levofloxacin, oral valacyclovir, doxycycline, systemic prednisolone, and autologous serum drops. However, corneal melting soon occurred, necessitating amniotic membrane transplantation, using a modified technique with sutures only on the corneal side and fibrin gluing on the limbal side of the graft in order to minimize inflammation.

The patient faced a high risk of perforation and despite the recommendation to defer surgery until inflammation is controlled, an emergency minimally invasive amniotic membrane transplantation was performed. This approach led to complete epithelialization and improved visual outcomes by one month postoperatively, highlighting the importance of creative surgical techniques for managing urgent OCP complications.

This case report underscores the necessity of individualized decision-making in managing complex ocular surface diseases where timing and surgical technique require precision and adaptability to avoid exacerbating inflammation while providing timely solutions and optimal visual outcomes.