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LETTER TO THE EDITOR
Year : 2020  |  Volume : 68  |  Issue : 7  |  Page : 1504-1505

Response to comments on: A comparative study of tarsorrhaphy and amniotic membrane transplantation in the healing of persistent corneal epithelial defects


1 Clinical Fellow, Medical Research Foundation, Department of Pediatric Ophthalmology and Strabismus, Sankara Nethralaya, Chennai, Tamil Nadu, India
2 Associate Professor, Department of Ophthalmology, All India Institute of Medical Sciences, Bathinda, Punjab, India
3 Professor, Department of Ophthalmology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, Uttarakhand, India

Date of Web Publication25-Jun-2020

Correspondence Address:
Dr. Anuradha Raj
Associate Professor, Department of Ophthalmology, All India Institute of Medical Sciences, Bathinda, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_163_20

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How to cite this article:
Dhillon HK, Raj A, Bahadur H. Response to comments on: A comparative study of tarsorrhaphy and amniotic membrane transplantation in the healing of persistent corneal epithelial defects. Indian J Ophthalmol 2020;68:1504-5

How to cite this URL:
Dhillon HK, Raj A, Bahadur H. Response to comments on: A comparative study of tarsorrhaphy and amniotic membrane transplantation in the healing of persistent corneal epithelial defects. Indian J Ophthalmol [serial online] 2020 [cited 2020 Jul 13];68:1504-5. Available from: http://www.ijo.in/text.asp?2020/68/7/1504/287504



Dear Editor:

We sincerely thank Srirampur A et al.[1] for their interest in our article [2] and hope to clarify their queries to the best possible extent.

After treatment for persistent corneal epithelial defect (PED) by amniotic membrane transplantation (AMT) or tarsorrhaphy, the conventional treatment was instituted. It comprised of artificial lubricants topically 2 hourly initially for a month and then a reduced dose to 6 times a day dose along with topical antibiotic (preservative free) 4 times a day for a week. Topical lubricant in gel form was also prescribed in patients with larger defects. Topical steroids (surface steroids e.g., fluromethalone) in low frequency and doses were prescribed to the patients who were post-operative patients for penetrating keratoplasty (however they were not given in cases where keratoplasty was performed for fungal corneal ulcers).[3]

Patients with chemical injury and other etiologies such as severe dry eye, ocular surface disorders, post chemical injuries and severe limbal stem cell deficiency do not respond well to treatment by AMT and tarsorrhaphy, hence were not included in the study. It has already been well established that the role of AMT is very limited in the healing of defects caused due to chemical injuries as these patients are candidates for additional procedure such as SLET (simple limbal epithelial transplantation).[3],[4]

Even the patients who underwent penetrating keratoplasty did not have had the above said mentioned etiologies as indication for the procedure if they were to be taken for just AMT or tarsorrhaphy.

Patients non responsive to the treatment of AMT or tarsorrhaphy were post penetrating keratoplasty patients with large PED's. Indication for penetrating keratoplasty in all these patients was deep corneal opacities with adherent leucoma (healed corneal ulcers). The culture reports of the recipient buttons for such patients revealed negative reports. However, the histopathology reports were indicative of high inflammatory cell percentage on the basis of which it was assumed that the probable etiology of the adherent leucomas was healed viral keratitis.[5] Given the neurotrophic nature of viral keratitis it corresponds with the fact that they do not respond to either of the treatment modalities.[6] We feel that these cases would respond better if modalities such as neurotisation of the cornea or additional procedures such as the use of auto logus serum are instituted.[7],[8]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Srirampur A, Kola P, Mansoori T, Vemuganti S. Comments on: A comparative study of tarsorrhaphy and amniotic membrane transplantation in the healing of persistent corneal epithelial defects. Indian J Ophthalmol 2020;68:1503-4.  Back to cited text no. 1
  [Full text]  
2.
Dhillon HK, Bahadur H, Raj A. A comparative study of tarsorrhaphy and amniotic membrane transplantation in healing of persistent corneal epithelial defects. Indian J Ophthalmol2020;68:29-33.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Wan S, Cheng J, Dong Y, Xie L. Epithelial defects after penetrating keratoplasty in infectious keratitis: An analysis of characteristics and risk factors. PLoSOne2018;13(11):e0208163.  Back to cited text no. 3
    
4.
Joseph A, Dua HS, King AJ. Failure of amniotic membrane transplantation in the treatment of acute ocular burns. Br J Ophthalmol2008;85:1065-9.  Back to cited text no. 4
    
5.
Seitz B, Das S, Sauer R, Mena D, Houfmann-Rummelt M. Amniotic membrane transplantation for persistent corneal epithelial defects in eyes after penetrating keratoplasty. Eye. 2009;23(4):840–48.  Back to cited text no. 5
    
6.
Shtein RM, Elner VM. Herpes simplex viral keratitis: Histopathology and allograft outcomes. Expert Rev Ophthalmol 2010;5:129-34.  Back to cited text no. 6
    
7.
Azher TN, Yin XT, Tajfirouz D, Huang AJW, Stuart PM. Herpes simplex keratitis: Challenges in diagnosis and clinical management. ClinOphthalmol2017;11:185-91.  Back to cited text no. 7
    
8.
Koaik M, Baig K. Corneal neurotisation. Curr Opin Ophthalmol 2019;30:292-8.  Back to cited text no. 8
    




 

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