Combination of Repeat Penetrating Keratoplasty with Amniotic Membrane Transplantation for Graft Failure with a Persistent Epithelial Defect after Infectious Keratitis

Here we report the successful management of corneal transplant failure with a persistent epithelial defect by using combined penetrating keratoplasty (PK) with amniotic membrane transplantation (AMT). A 75-year-old woman who had an exacerbation of pseudophakic bullous keratopathy in her left eye had been treated by PK 4 years before. One year after the surgery, endothelial graft rejection with graft failure developed despite intensive topical corticosteroids being prescribed. Unfortunately, severe corneal ulceration in the graft with an anterior chamber reaction was noted 2 days prior to her visit to our department. The results from corneal scrapings showed Pseudomonas infection. After 2 weeks of fortified antibiotics treatment, the corneal ulceration was controlled but a persistent epithelial defect remained unhealed. Repeat PK combined with AMT was performed to rescue her vision. Three weeks after the combined procedure, the amniotic membrane patch was absorbed. Corneal transparency was maintained and complete healing of the epithelium without recurrences of infection was noted. Vision improved to 6/20 during 5 months of follow up. AMT may play an adjuvant role in the management of highrisk repeat corneal transplantation.