Band-Shaped Keratopathy

In cases with band-shaped keratopathy (BSK), many patients had come to terms with their irreversibly blind eyes, but suffered from poor cosmetic appearances and hence low self-esteem. Still, they did not want an invasive cosmetic corneal transplant.

I approached these cases like a corneal pathology, and on lifting the BSK calcific plaques, I was surprised to see in majority of cases a smooth stromal base that could be draped with the amniotic graft centrally and be secured with glue in addition to a single perilimbal suture for a long-term application on these uneven corneal shapes to excellent cosmetic outcomes.

In all cases, I used mitomycin C 0.04% for 30 seconds prior to application of amniotic graft. Three cases had a recurrence of their BSK, but much less than that at preoperative levels, and patients appreciated the near-normal cosmetic appearance of their operated eyes.

Prototype of BSK cases are explained in ▶ Fig. 8.1, ▶ Fig. 8.2, ▶ Fig. 8.3.

8.3 Restoring and Rejuvenating Non-Healing Corneal Surface

In cases with delayed epithelial healing, especially from neuropathy and ocular surface instability (▶ Fig. 8.4 and ▶ Fig. 8.5), I have found amniotic graft application to be especially useful not only as a less invasive surgical approach but also as a cosmetically oriented endeavor.

In some cases, adherence of graft was achieved with Tisseel glue (most of these had normal corneal contour), while in some (with irregular corneal shapes), I always applied a single, perilimbal 10–0 nylon suture.

I have used it for cases of anterior and posterior corneal surgery stabilization including in cases such as shown in ▶ Fig. 8.6 where poor anterior corneal healing led to a patient being dissatisfied with his surgeon despite a well-done Descemet stripping automated endothelial keratoplasty (DSAEK) surgery and on anterior clearance with amniotic membrane transplantation (AMT) recovered vision and optical clarity.

8.4 ProKera

Amniotic membrane in a bandage contact lens is a modality that can help heal the ocular surface as well as decrease associated inflammation and restore surface stability in numerous cases, where I have used it for refractive complications, that were referred to me for reasons of poor healing or complications limited to surface corneal issues.

In associated images, you can see applications in Lasik epithelial ingrowth, Intacs wound healing, corneal dystrophy, corneal scars and irregularities, non-healing corneal surface post laser Corneoplastique for corneal scars, preoperatively to prepare ocular surface for laser correction of corneal irregularities, etc. (▶ Fig. 8.7, ▶ Fig. 8.8, ▶ Fig. 8.9, ▶ Fig. 8.10, ▶ Fig. 8.11, ▶ Fig. 8.12, ▶ Fig. 8.13, ▶ Fig. 8.14, ▶ Fig. 8.15, ▶ Fig. 8.16).

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