Case study: persistent keratitis OS presents in 68-year-old woman

Figure 1. Infectious keratitis before application of Prokera Slim.

Presentation

A 68-year-old White woman was referred for persistent keratitis OS and failure on multiple medications: Restasis, Xiidra, prednisolone 1%, Lotemax 0.5%, and Cequa. She was using Systane preservative-free drops, 4 to 6 times daily. Sodium fluorescein staining revealed marked keratitis OS (Figure 1).

Caldwell

Treatment

I educated the patient about her condition, and after lengthy discussion it was decided that a Prokera Slim amniotic membrane would be used to treat the OS.

Follow-up

I instructed my patient to make an appointment to have the Prokera ring removed when her vision cleared (due to membrane dissolving). Her vision cleared 6 days after Prokera Slim insertion. At this point, she was only using Systane preservative-free artificial tears. The ring was removed, and the patient was placed on autologous serum eye drops 20%, 1 drop 6 times per day.

Figure 2. The eye 6 days after application of Prokera Slim. (All figures courtesy of Greg Caldwell, OD, FAAO)

Outcome and observations

The patient presented with a chronic and persistent keratitis OS. The cause was multifactorial with 1 component being toxic keratitis from the various pharmaceuticals used. This patient needed a therapy that supported wound healing and not wound covering. A Prokera Slim was used to provide wound healing. The patient reported no problems or discomfort with Prokera Slim during the 6-day treatment (Figure 2).

The patient responded wonderfully to the therapy and reported increased comfort and improved vision.

READ Dr.Caldwell's full article: Cryopreserved amniotic membrane excels at healing ocular surface wounds