AMNIOTIC MEMBRANE TRANSPLANTATION IN THE TREATMENT OF SHIELD ULCER IN VERNAL KERATOCON JUNCTIVITIS.

Objectives: To evaluate the efficacy and safety of amniotic membrane transplantation (AMT) for thetreatment of shield ulcer in vernal keratoconjunctivitis (VKC) with giant papillae.Material and Methods: This retrospective study was conducted in the Department of ophthalmologyHayatabad Medical Complex Peshawar from May 2009 to May 2010. In this study 30 patients of VKC withshield ulcer were evaluated for a period of one year. Both gender of 3 - 26 years age patients were included inthis study. Patients were enrolled and informed written consent was taken. Amniotic membraneimplantation was performed in thirty patients with grade 2 or grade 3 shield ulcers unresponsive toconventional medical treatment lasting an average of 14 weeks. Surgery was done under general anesthesiausing amniotic membrane as a therapeutic contact lens. Their record was maintained and all patients withthe mean 4 months follow-up were evaluated for about safety, efficacy, and side effect of the treatment.Results: Thirty eyes of thirty patients with grade 2 shield ulcer with opaque base) and grade 3 (plaque likelesions) not responding to steroid therapy with or without surgical debridement were enrolled. The ulcershealed with disintegration or retraction of the membrane in all patients within 2 weeks. A significantdecrease in symptoms and complete reepithelialization of the corneal ulcers were observed in all caseswithin the first 7 days. The eyes remain stable during a mean follow-up of 4 months, with no intraoperativeor postoperative complications. Absorption of amniotic membrane occurred with in 2 to 3 weeks timeleaving the underlying ulcer completely epithelized.Conclusion: Amniotic membrane transplantation in combination with debridement is a safe and effectivesurgical modality in the management of shield ulcers. Further studies are warranted to confirm the efficacyof amniotic membrane transplantation in the management of shield ulcer.