Ocular surface rehabilitation Application of human amniotic membrane in high-risk penetrating keratoplasties

Human amniotic membrane is a versatile tool for management of ocular surface disorders. This study evaluates the effect of cryopreserved human amniotic membrane [hAM] on one-year survival of penetrating keratoplasties [PKP] in high-risk recipients. This is a retrospective noncomparative cohort study of 58 consecutive eyes undergoing PKP with concurrent placement of a self-retained cryopreserved hAM [PROKERA®] at a tertiary care center from January 2009 to July 2010. Mean patient age was 66.7 +/- 17.2 years and 30 [54%] were males. 51 eyes were pseudophakic and one aphakic. 27 eyes were glaucomatous; 24 had glaucoma drainage device and 2 had previous endocyclophotocoagulation. 12 patients had PKP for the first time and 46 had repeat PKP [average number of prior PKP = 1.63 +/- 1.1, range: 1-5]. Risk factors for graft failure included repeat PKP [79.3%], corneal neovascularization [51.7%], preexisting glaucoma [46.6%], and presence of anterior synechiae [37.9%]. Both First Transplant and Repeat Transplant groups had similar survival rates until 6 months after transplant [75% vs 74%, odds ratio = 1.06, p = 1.00]. At 12 months, First Transplant group showed a better survival rate [67% vs 43%, odds ratio = 2.60, p = 0.20]. Eyes with >3 risk factors had a higher graft failure rate [odds ratio = 5.81, p = 0.003]. Survey of the literature suggests that high-risk PKP with concurrent hAM placement demonstrate comparable graft survival. Presence of multiple risk factors is associated with poor survival