Amniotic membrane transplantation combined with cryotherapy vs. lamellar keratoplasty for medically refractory peripheral ulcerative keratitis: a retrospective cohort study.

BACKGROUND: Medically refractory peripheral ulcerative keratitis (PUK) is a severe condition requiring urgent surgery. This study compares the clinical outcomes of amniotic membrane transplantation (AMT) combined with cryotherapy vs. lamellar keratoplasty (LKP) for this high-risk group.

METHODS: This retrospective cohort study evaluated patients with refractory PUK who underwent either AMT or LKP with a 12-month follow-up. Outcome measures included ulcer healing rate, best-corrected visual acuity (BCVA), epithelialization time, and recurrence rate.

RESULTS: A total of 58 patients (58 eyes) were included (AMT: n = 28; LKP: n = 30). Primary ulcer healing rates were comparable between the groups (AMT: 78.6%, LKP: 76.7%; P = 0.862). Both groups showed similar BCVA improvements up to 6 months postoperatively. However, the LKP group demonstrated significantly faster epithelialization (median 6 vs. 12 days; P < 0.05), superior BCVA at 12 months (P = 0.019), and a lower disease recurrence rate (10.0% vs. 32.1%; P = 0.038), although AMT demonstrated a superior safety profile with no procedure-related complications. Concurrent autoimmune diseases significantly prolonged epithelialization in both cohorts.

CONCLUSIONS: LKP provides superior long-term optical/structural restoration and a lower recurrence rate, making it the definitive treatment for refractory PUK. However, AMT matches LKP in primary healing and mid-term efficacy. Amid global donor shortages, AMT serves as an invaluable, safe bridging therapy to stabilize the ocular surface and manage acute inflammation before definitive keratoplasty.