[Should indications for amniotic membrane transplantation be altered in concurrent rheumatoid polyarthritis?].

BACKGROUND

Amniotic membrane transplantation (AMT) shows good results in corneal epithelial defects or ulcerations. However, in patients with rheumatoid arthritis (RA) these corneal defects represent a somewhat greater challenge. We address the question whether AMT has to be indicated differently in RA patients.

PATIENTS AND

METHODS

We retrospectively analysed 25 AMTs performed between October 1998 and August 2000 in 22 patients for corneal epithelial defects and ulcerations. In 8 patients (11 AMTs) RA was present (group A) and no RA (group B) was found in 14 patients (14 AMTs).

RESULTS

Epithelial closure could be achieved in 24/25 cases after a mean of 24.9 days. In 15/25 cases the epithelium remained closed over a minimum of 3 months (successful AMT). In group B, 12/14 AMTs (85.7%) were successful, but only 3/11 AMTs (27.3%) were successful in group A.

DISCUSSION: In addition to the pronounced keratoconjunctivitis sicca, immune-mediated inflammatory aspects are suspected to be the reason for the poor results of AMT in RA patients. But as alternative surgical procedures (e.g. keratoplasty) implicate specific problems in RA, we believe that after failure of conservative treatment AMT is a reasonable procedure for corneal defects even in RA patients.