Freeze-Dried Amniotic Membrane for Filamentary Keratitis

Filamentary keratitis is a condition in which degenerated epithelial cells and mucous adhere to the corneal surface. It is most likely related to abnormalities of the tear film and/or corneal surface and is known to be a driver and risk factor for numerous ocular surface diseases. Treatment is generally started with topical therapy and lubricating drops. If needed, it may be escalated to include the use of a bandage contact lens and agents to decrease the viscosity of mucous in the tear film.

Presentation

This is a case of a 47-year-old female who presented with painful sandy sensation in both eyes. She had a medical history of dry eye disease and diabetes. On ocular examination, diffuse filaments were evident OU and her visual acuity was 20/50 OD and 20/40 OS. Concomitant medications included Metformin 500 mg. The patient was diagnosed with filamentary keratitis OU and keratoconjunctivitis sicca OU (Figure 1).

Diagnosis and Treatment

The patient was diagnosed with filamentary keratitis and keratoconjunctivitis sicca in both eyes. She was treated with a freeze-dried amniotic membrane with an overlying bandage contact lens, compounded 10% acetylcysteine eye drops TID OD, and Refresh Celluvisc (Allergan, an AbbVie Company) QHS OU. Following initial treatment, the patient’s symptoms have subjectively improved and BCVA is 20/25 OD and 20/20 OS. Fluorescein staining showed resolution of the filaments and near resolution of the cornea (Figure 2).

Discussion

A 47-year-old female with diabetes presented with severe ocular pain OU. Ocular examination revealed filamentary keratitis OU, but OD > OS. She was subsequently treated with a freeze-dried amniotic membrane, compounded acetylcysteine, and viscous tears, which resulted in subjective improvement in symptoms and objective improvement in visual acuity.