Lamellar Keratoplasty Combined with Amniotic Membrane Transplantation for the Treatment of Corneal Perforations: A Clinical and In Vivo Confocal Microscopy Study

Figure 2

Healing of a central corneal perforation after lamellar keratoplasty combined with amniotic membrane transplantation (Case 1). Corneal perforation was happened during DALK, so we change surgical plan into lamellar keratoplasty combined with amniotic membrane transplantation to remedy. (a) A 17-year-old girl with a corneal ulcer associated with herpetic stromal necrotizing keratitis. The deep ulcer with descemetocele was shown. (b) 3 days after surgery, the anterior chamber was reformed. (c) 8 days after surgery, the corneal edema was reduced. (d) 20 days after surgery, a relatively stable cornea surface with an intrastromal opaque AM layer was seen. (e) Corneal stroma-derived cells were populated in the AM at 20 days after surgery in vivo confocal microscopy images. (f) The structure of the endothelial cell layer was unclear because of corneal edema. (g) 2 months after surgery, a thin demarcation line between the AM and the stroma is visible. (h) Corneal stroma-derived cells were increased at 2 months after surgery in vivo confocal microscopy images. (i) The structure of the endothelial cell layer was unclear at the perforation site and the neighbouring endothelial cells were about 1247 ± 36 mm² at 2 months after surgery in confocal microscopy examination. (j) A nearly normal corneal thickness was seen at 6 months postoperatively, with a low reflective nebula. (k) Corneal stroma-derived cells were still visible with a flaky signal in vivo confocal microscopy images at 6 months postoperatively. (l) Confocal microscopy examination showed the endothelial cell layer at the perforation site which was not smooth. The size of endothelial cells was uniformly increased and the density was about 989 ± 61 mm² at 6 months postoperatively near the perforation site. (m) 20 months after surgery, the corneal surface was totally stable. The VA was better than the preoperative level (from CF to 0.5). (n) Corneal stroma-derived cells were almost not visible in vivo confocal microscopy images. (o) Confocal microscopy examination showed the endothelial cell layer near the perforation site was clear and was about 1143 ± 17 mm² at 20 months after surgery.

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