Ezzeldin Ezzeldin Ramadan, Tharwat Ehab, Mohammed Mohammed Hazem Elbadry, Sayed Ahmed Esam, Elgazzar Akram Fekry, Hassan Ahmed Riad Elzaher, Soliman Haitham Beshr, Omran Mohamed Yahia, Amer Ramy Saleh, Abdelhameed Hazem Mohamed, Abdella Walid Shaban, Elsayed Abdelkader Amr Mohammed
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt.
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Med Hypothesis Discov Innov Ophthalmol. 2025 Jul 31;14(2):1-8. doi: 10.51329/mehdiophthal1518. eCollection 2025 Summer.
Resistant fungal keratitis is a major cause of corneal blindness, particularly in resource-limited regions where donor tissue is scarce. Amniotic membrane transplantation (AMT) offers potential benefits through its anti-inflammatory, anti-proteolytic, and epithelialization-promoting effects. This study evaluated the efficacy and safety of AMT for treatment-resistant fungal corneal ulcers.
This prospective, single‑arm study enrolled consecutive patients with microbiologically confirmed, treatment‑resistant fungal corneal ulcers at Al‑Azhar University Hospital, Damietta, between January 2022 and October 2023. All patients underwent standardized single- or double-layer AMT. Baseline and follow-up assessments included best-corrected distance visual acuity (BCDVA, logarithm of the minimum angle of resolution [logMAR]), ulcer size, anterior chamber reaction and depth, and presence of blepharospasm or pain (visual analog scale). Clinical evaluations were performed at baseline, 1 day, and 1, 3, and 6 months postoperatively. Treatment success was defined as complete resolution or significant improvement over 6 months.
A total of 24 patients (mean [standard deviation] age, 59 [7.5] years; 3:1 male-to-female ratio) with resistant fungal corneal ulcers were studied. Most were rural residents (n = 17, 70.8%), and nearly half were farmers (n = 11, 45.8%). Common comorbidities included hypertension and diabetes mellitus. The median baseline ulcer area was 3 mm²; most ulcers were central (n = 10, 41.7%) or paracentral (n = 8, 33.3%), and 12.5% (n = 3) had perforations. At 6 months, significant improvements were observed: median BCDVA improved from 3.0 logMAR to 2.0 logMAR ( = 0.001), ulcers completely closed ( = 0.001), and the pain score dropped from 2 to 0 ( = 0.001). Anterior chamber reaction and blepharospasm also improved significantly (both = 0.001). Overall, 91.7% (n = 22) achieved complete resolution or marked improvement, and two patients required further surgery. The results showed progressive benefits throughout the follow-up period.
AMT is a safe and effective adjunctive treatment for resistant fungal keratitis, particularly when corneal donors are scarce. The procedure promotes ulcer healing, relieves pain, and improves visual outcomes. Controlled trials are required to confirm these findings and refine patient selection.
耐药性真菌性角膜炎是导致角膜盲的主要原因，在供体组织稀缺的资源有限地区尤为如此。羊膜移植（AMT）通过其抗炎、抗蛋白水解和促进上皮化的作用提供了潜在益处。本研究评估了AMT治疗耐药性真菌性角膜溃疡的疗效和安全性。
这项前瞻性单臂研究纳入了2022年1月至2023年10月期间在达米埃塔的爱资哈尔大学医院连续就诊的微生物学确诊的耐药性真菌性角膜溃疡患者。所有患者均接受了标准化的单层或双层AMT。基线和随访评估包括最佳矫正远视力（BCDVA，最小分辨角对数[logMAR]）、溃疡大小、前房反应和深度，以及睑痉挛或疼痛的存在情况（视觉模拟量表）。在基线、术后1天以及术后1、3和6个月进行临床评估。治疗成功定义为在6个月内完全缓解或显著改善。
共研究了24例耐药性真菌性角膜溃疡患者（平均[标准差]年龄，59[7.5]岁；男女比例为3:1）。大多数为农村居民（n = 17，70.8%），近一半为农民（n = 11，45.8%）。常见的合并症包括高血压和糖尿病。基线溃疡面积的中位数为3mm²；大多数溃疡位于中央（n = 10，41.7%）或旁中央（n = 8，33.3%），12.5%（n = 3）有穿孔。在6个月时，观察到显著改善：BCDVA中位数从3.0 logMAR提高到2.0 logMAR（P = 0.001），溃疡完全闭合（P = 0.001），疼痛评分从2降至0（P = 0.001）。前房反应和睑痉挛也有显著改善（均为P = 0.001）。总体而言，91.7%（n = 22）实现了完全缓解或明显改善，两名患者需要进一步手术。结果显示在整个随访期间都有渐进性益处。
AMT是治疗耐药性真菌性角膜炎的一种安全有效的辅助治疗方法，尤其是在角膜供体稀缺的情况下。该手术可促进溃疡愈合、缓解疼痛并改善视力结果。需要进行对照试验以证实这些发现并优化患者选择。
