Management of a neurotrophic deep corneal ulcer with amniotic membrane transplantation in a patient with functional monocular vision

RATIONALE Amniotic membrane transplantation (AMT) has been performed therapeutically in humans for over 100 years. In recent 2 decades AMTs have been used increasingly and successfully to treat various types of ophthalmic indications. PATIENT CONCERNS An 83-year-old man was referred to our eye hospital with a refractory neurotrophic deep corneal ulcer of the left eye. DIAGNOSES The best-corrected visual acuity of the left eye was 0.5 (0.3 logMAR) and of the right eye was 0.05 (1.3 logMAR), which was caused by a central retinal vein occlusion 5 years previously. In cases of binocular vision, a large amniotic membrane patch can cover the whole cornea, including the optical axis. However, in cases with functional monocular vision, as in the case reported here, the AMT has to be performed without the involvement of the optical axis to ensure vision for the patient. Otherwise the patient would have a massively restricted view like looking through waxed paper for at least 2-4 weeks until the overlay dissolved. INTERVENTIONS For this case, an AMT using a modified sandwich technique was applied without involvement of the optic axis to ensure vision for the patient. This case report illustrates this eye's course of healing over time. OUTCOMES A reduction in the inflammation and healing of the corneal ulcer could be seen. In addition, the corneal vascularization decreased. Six months after the AMT, a slit-lamp examination revealed stable findings. The best-corrected visual acuity of the left eye had increased to 0.8 (0.1 logMAR). LESSONS To the best of our knowledge, a case report on the management of a neurotrophic deep corneal ulcer with AMT in a patient with functional monocular vision has never been undertaken before.