Amniotic membrane improves severe autoimmune-related KCS and NK outcomes

A case report presented at the Association of Cataract and Refractive Surgery (ASCRS) Annual Meeting highlights the successful management of severe keratoconjunctivitis sicca (KCS) and neurotrophic keratopathy (NK) secondary to autoimmune disease using cryopreserved amniotic membrane (CAM) alongside systemic and topical therapies.

The report describes a 32-year-old woman with a history of lupus and common variable immunodeficiency who presented with advanced ocular surface disease, including 4+ superficial punctate keratitis, negligible tear film, significant conjunctival injection, and reduced corneal sensation in both eyes. Visual acuity was 20/100 in the right eye and 20/400 in the left eye at presentation.

Initial treatment included artificial tears, cyclosporine, topical steroids, immunoglobulin therapy, and 2 CAM applications per eye. After 5 weeks, the patient showed partial improvement, with reduced injection and visual acuity improving to 20/70 in both eyes, though tear film remained minimal and staining persisted.

Additional treatment in the left eye with 2 more CAM applications and a 72-hour collagen shield over 4 weeks led to marked improvement, with no injection, minimal staining, improved TBUT and corneal sensation, and visual acuity of 20/20 in the right eye and 20/30 in the left eye.

Reference

Bauza A, et al. Management of Severe Keratoconjunctivitis Sicca and Neurotrophic Keratopathy in a Patient with Lupus and Common Variable Immunodeficiency. Poster presented at: ASCRS Annual Meeting; April 10–13, Washington, DC.