Transcript PowerPoint Template

Corneal Tattooing with Amniotic Membrane
Woo Chan Park M.D., Won Yeol Ryu M.D.
Dept. of Ophthalmology, College of Medicine, Dong-A University
Busan, Korea
The authors have no financial interest in the subject matter of this poster.
PURPOSE
 The purpose of this study was to investigate the effects
of Davidson Marking Dye tattooing with permanent
amniotic membrane transplantation (AMT) on treatment
of corneal opacity and/or bullous keratopathy in patients
who suffered from pain, photophobia and cosmetic
problem.
Page  2
METHODS
 We performed corneal tattooing with amniotic membrane
transplantation in 27 eyes with corneal opacity and/or bullous
keratopathy in patients who suffered cosmetic problem, pain,
poor visual potential, photophobia from January 2002 to July
2009.
 The average age of the study group was 57.7 years old
(M:F=16:11) and the average follow-up period was 7.6
months (2~26 months)(Table 1).
Page  3
Table 1. Demography
Case
Sex/Age
Op. site
Preop. cause
Pre-op. V/A
Pain Photo-phobia
1
F/63
OD
Ocular trauma
FC
Yes
Yes
2
F/64
OD
Post-infectious corneal opacity
HM
Yes
Yes
3
F/64
OS
Post-infectious corneal opacity
LP(+)
Yes
Yes
4
M/31
OD
Ocular trauma
0.1
Yes
Yes
5
M/43
OS
Ocular trauma
0.06
Yes
Yes
6
F/37
OD
Lipid keratopathy
0.08
Yes
Yes
7
M/60
OD
Ocular trauma
HM
Yes
Yes
8
M/64
OD
Ocular trauma
0.06
Yes
Yes
9
M/75
OS
Ocular trauma
HM
Yes
Yes
10
F/27
OS
Lipid keratopathy
0.1
Yes
Yes
11
M/53
OD
Corneal ulcer
LP(-)
Yes
No
12
M/67
OD
Glaucoma
LP(+)
Yes
Yes
13
M/81
OD
Glaucoma
FC
Yes
Yes
14
M/62
OS
Glaucoma
0.06
Yes
Yes
15
F/71
OS
Ocular trauma
HM
Yes
Yes
16
M/57
OS
Post-infectious corneal opacity
0.1
Yes
Yes
17
F/62
OS
Ocular trauma
FC
Yes
Yes
18
M/40
OS
Pseudophakia, glaucoma
LP(-)
Yes
Yes
19
M/72
OD
PED
LP(+)
Yes
Yes
20
F/63
OD
Pseudophakia, glaucoma
0.02
Yes
Yes
21
M/76
OD
PED
0.04
Yes
Yes
22
M/57
OD
Ocular trauma
HM
Yes
Yes
23
M/54
OS
Ocular trauma
HM
Yes
Yes
24
F/53
OS
Post-infectious corneal opacity
0.04
Yes
Yes
25
M/66
OD
Pseudophakia, glaucoma
0.02
Yes
Yes
26
F/50
OD
Post-infectious corneal opacity
LP(+)
Yes
No
27
F/45
OS
Corneal ulcer
FC
Yes
Yes
• V/A=visual acuity, FC=finger count, HM=Hand movement, LP=light perception, PED=persistent corneal epithelial defect
Page  4
Follow-up
2
2
4
2
5
3
5
12
2
8
3
6
6
14
26
17
7
2
9
5
4
5
22
18
6
4
6
METHODS
 Under the topical anesthesia, corneal epithelium was removed using No.
15 blade (Fig. 1-A) and the Davidson marking dye was applied on the
cornea. We performed multiple punctures with 23G needle into the
anterior stroma (Fig. 1-B,C).
 The amniotic membrane was designed smaller than epithelial
debridement diameter (Fig. 1-D) and was placed on the cornea and was
sutured purse-string manner with 10-0 nylon (Fig. 1-E,F).
 Therapeutic soft lens was worn and pressure patch was done.
 Postoperatively, we assessed the resolution of pain and photophobia,
and the persistence of the dye tattooing.
Page  5
A
B
C
D
E
F
Fig. 1. Procedure of tattooing and amniotic membrane transplantation (AMT) (A~F)
Page  6
RESULTS
 Postoperative pain relief was obtained in 25 eyes out of 27 eyes (92.6%),
and the photophobia was improved in 24 eyes of 27 eyes (96%) (Table 2).
 The dye was disappeared more than 50% in only 2 eyes (Fig. 2~5).
 In 1 eye (case 11), evisceration was carried out due to ocular
hypertension. And in another 1 eye (case 22), permanent amniotic
membrane transplantation was performed due to persistent corneal
epithelial defect.
 Postoperative visual acuity was similar to the preoperation.
Page  7
Table 2. Surgical outcome
Case
Preop. cause
Post-op. V/A
1
2
3
4
5
6
7
8
9
10
11*
12
13
14
15
16
17
18
19
20
21
22*
23
24
25
26
27
Ocular trauma
Post-infectious corneal opacity
Post-infectious corneal opacity
Ocular trauma
Ocular trauma
Lipid keratopathy
Ocular trauma
Ocular trauma
Ocular trauma
Lipid keratopathy
Corneal ulcer, glaucoma
Glaucoma
Glaucoma
Glaucoma
Ocular trauma
Post-infectious corneal opacity
Ocular trauma
Pseudophakia, glaucoma
PED
Pseudophakia, glaucoma
PED
Ocular trauma
Ocular trauma
Post-infectious corneal opacity
Pseudophakia, glaucoma
Post-infectious corneal opacity
Corneal ulcer
0.02
HM
LP(+)
0.08
0.06
0.1
HM
0.08
HM
0.1
LP(-)
LP(+)
FC
0.08
FC
0.1
FC
LP(-)
LP(+)
0.02
0.04
HM
FC
0.04
0.02
LP(+)
FC
Pain↓
Photophobia↓
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
No
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
No
O
O
25/27 (92.6%)
23/25 (96.0%)
2/27 (7.4%)
V/A=visual acuity, FC=finger count, HM=Hand movement, LP=light perception, PED=persistent corneal epithelial defect
Page  8
Loss of dye
(>50%)
O
O
-
A
B
Fig. 2. Case 5. Ectopic pupil
Partial dye-AMT was done.
A. POD 1 day
B. POD 6 months, dye was still remained
A
B
Fig. 3. Case 16. Traumatic aniridia
Page  9
Hole dye-AMT & pupilloplasty were done.
A, POD 3 months
B. stained with fluororescein
A
B
C
D
Fig. 4. Case 14. Bullous keratopathy
Page  10
Hole dye-AMT was done.
A. POD 1 day, B. POD 5 days, C. POD 1 week, reepithelialization was done
D. POD 14 months, dye was nearly disappeared
A
B
C
D
Fig. 5. Case 21. Herpetic keratitis with persistent corneal epithelial defect
Page  11
Dye-AMT was done.
A. POD 3 days B. POD 1 week C. POD 2 months
D. POD 8 months, dye was still remained
CONCLUSIONS
The combined operation of corneal tattooing
and amniotic membrane transplantation is a
good choice for treatment of corneal opacity
and/or bullous keratopathy with regard to
cosmetic problem, pain, and photophobia.
Page  12