Sandwich Technique and Amniotic Membrane Transplantation as an Effective Method in Repairing Corneal Perforations

Abstract Purpose To evaluate effectiveness of human amniotic membrane (hAM) transplantation in patients with non-traumatic corneal perforation. Methods This retrospective chart review included the patients who were underwent hAM transplantation with sandwich technique between March 2020 to January 2023 at Ege University Hospital, Turkey. Medical records of the patients including demographic data, best corrected visual acuity (BCVA) that was measured with Snellen chart, detailed ophthalmological examination and the need for additional surgical intervention after hAM transplantation were evaluated. Complications, anatomical and functional results were presented. Results A total 9 eyes of 9 patients with non-traumatic corneal perforations were evaluated between 2020 and 2023. Size of perforation was ≤ 3 mm in all the eyes. The mean age of the patients was 67.77 ± 15.52. Female to male ratio was 1/8. Sandwich technique was used in all patients for hAM transplantation. Five of cases (55.55%) had infectious etiology and 4 of them (44.44%) had inflammatory etiology. Of the infectious corneal perforations, 3 (33.33%) were herpes simplex virus-induced neurotrophic keratopathy and 2 (22.22%) were bacterial keratitis. The mean residence time of the amniotic membrane on the ocular surface was 21 ± 8.05 days. Tectonic keratoplasty was needed in 1 eye (11.11%). Corneal patch grafting was required in 1 of eyes (11.11%). Evisceration was performed in 1 eye (11.11%) of a patient with no light perception who had no visual prognosis. Amniotic membrane detachment was observed in one patient as a surgical-related complication associated with hAM transplantation. Conclusions hAM transplantation is one of the successful treatment methods in treatment of relatively small corneal perforation. Considering the difficulty of finding a donor cornea and the easier access to the amniotic membrane, it seems like a good alternative treatment to reduce or postpone the need for tectonic keratoplasty.