Cryopreserved Amniotic Membrane (ProKera) Treatment of Anterior Stromal Haze Secondary to HSV Keratitis

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Richard Maharaj, OD, FAAO


Herpes Simplex Keratitis, Cryopreserved Amniotic Membrane


Purpose:  To review the efficacy of cryopreserved amniotic membrane (CAM) to reduce stromal scarring in a case of refractory anterior stromal haze related to herpes simplex keratitis (HSK).  The initial treatment course of conventional topical steroid and oral antiviral was completed followed by the addition of CAM to further address scarring.

Methods: Clinical presentation of a cornea with stromal haze that was refractory to previous steroid and topical and oral anti-viral therapy were documented with anterior segment smartphone capture.  Best corrected visual acuity was documented to contrast clinical observations.  Use of the cryopreserved amniotic membrane (CAM) Prokera® Slim was successful in reducing both anterior stromal haze and best corrected acuity. 

Conclusions:  CAM treatments may provide an additional therapeutic agent in the management of anterior stroma infiltration and scarring secondary to HSK.  As demonstrated in this case, patients with visually significant stromal haze that is non-responsive to topical therapy may benefit from non-surgical placement of CAM.  Due to the accessibility of CAM in private clinical settings, it should be considered as a viable new option for patients who have exhausted other traditional treatments and perhaps be considered in early infectious corneal disease states.


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1. Herpes simplex virus keratitis: a treatment guideline. . White ML, Chodosh J. 2014, The American Academy of Ophthalmology Clinical Guidelines. .
2. Normal Human Keratocyte Density and Corneal Thickness MEasurement by Using Confocal Microscopy in Vivo. Patel SV, McLaren JW, Hodge DO, Bourne WM. February 2001, Investigative Ophthalmology & Visual Science, Vol. 42, pp. 333-339.
3. Twenty-five year panorama of corneal immunology . Dana MR, Qian Y, Hamrah P. 2000, Cornea, Vol. 19, pp. 625-643.
4. Amniotic membrane transplantation in infectious corneal ulcer. Kim JS, Kim JC, Hahn TW, Park WC. 7, Oct 2001, Cornea, Vol. 20, pp. 720-726.
5. Effect of amniotic membrane transplantation on the healing of bacterial keratitis . Barequet IS, Habot-Wilner Z, Keller N, Smollan G, Ziv H, Belkin M, Rosner M. 1, Jan 2008, Invest Ophthalmol Vis Sci, Vol. 49, pp. 163-7.
6. Herpetic Eye Disease Study. Institute, National Eye. July 2004.
7. Identification and characterization of herpes simplex virus-specific CD4+ T cells in corneas of herpetic stromal keratitis patients. Verjans GM, Remeijer L, van Binnendijk RS, et al. 2, 1998, J Infect Dis , Vol. 177, pp. 484-8.
8. Improvement of HSV-1 necrotizing keratitis with amniotic membrane transplantation. Heiligenhaus A, Meller D, Meller D, et al. 2001, Invest Ophthalmol Vis Sci, Vol. 42, pp. 1969-1974.
9. Heavy Chain-Hyaluronan/Pentraxin 3 from Amniotic Membrane Suppresses Inflammation and Scarring in Murine Lacrimal Gland and Conjunctiva of Chronic Graft-versus-Host Disease . Yoko Ogawa, Hua He, Shin Mukai, Toshihiro Imada, Shigeru Nakamura, Chen-Wei Su, M. 42195, February 2017, Nature, Vol. Scientific Report 7.
10. Role of IL-17 and Th17 cells in herpes simplex virus-induced corneal immunopathology. Suryawanshi A1,. Veiga-Parga T, Rajasagi NK, Reddy PB, Sehrawat S, Sharma S, Rouse BT. 4, Aug 2011, J Immunol, Vol. 187, pp. 1919-1930.