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Has amniotic membrane transplantation to be indicated differently in case of rheumatic polyarthritis?B. Gabler, C. P. Lohmann
Background: Amniotic membrane transplantation has become increasingly important in therapy of severe ocular surface disease. In a continuously widening spectrum of indications, persisting epithelial defects and corneal ulcerations are still the classic indications with very good prospect for success. In part of the patients with epithelial defects / ulcerations, rheumatic polyarthritis (RA) is present as causative or concomitant disease. That possibly influences the success of AMT.
Patients and Methods: We performed AMT in 17 patients with persisting epithelial defects or ulcerations of the cornea during the last 15 months. In 6 of 17 patients RA was present and was either already treated or inactiv. Post-AMT topical medication consisted of corticosteroidal and antibiotic eye drops (temporary) as well as lubricating eye drops (continued).
Results: In 13 of 17 patients, including all patients without RA and 2 patients with RA, epithelial closure could be achieved. All 4 patients, who did not reach epithelial closure or who experienced a relapse within a short peroid, RA was present. Thus only 2 from 6 RA-patients showed a positive result after AMT.
Discussion: Although AMT resulted in a stable closure of the corneal epithelium in all patients (n=11) without RA, this could be achieved in only 2 from 6 patients with RA. Before performing AMT in a RA-patient, all conservative measures could be pursued and rheumatic activity should be re-evaluated. If AMT is performed, these patients have to be followed up very closely.
University Eye Clinic, Franz-Josef-Strauss-Allee, 93042 Regensburg, Germany