AIM: To investigate the clinical effect for treating bullous keratopathy(BK)by anterior corneal stromal acupuncture combined with amniotic membrane transplantation.

METHODS: Totally 35 patients(35 eyes)with bullous keratopathy were treated by corneal stromal acupuncture combined with amniotic membrane transplantation. All patients preoperative and postoperative underwent anterior segment OCT, corneal topography, corneal sensitivity and confocal microscopy. To observe postoperative ocular symptoms in patients with BK, recurrence of bulla, changes in corneal thickness, corneal sensitivity and changes in the organizational structure of the layers of the cornea.

RESULTS: Thirty-five were followed up for 6-18mo. The symptom of pain disappeared in 32 cases(91%)in the first day after operation and did not recur during follow-up. The symptom of pain relieved in 3 cases(9%)in the first day after operation and disappeared in 3 days. Corneal epithelium of 9 cases(26%)were all healed within 1wk, 21 cases(60%)were all healed within 2wk, and 5 cases(14%)were all healed within 3wk. Following up for 6-18mo, there was no recurrence of symptoms or bulla. A small amount of tiny bubbles in the surrounding area appeared in 2 cases after 3 and 4wk. All patients had no neovascularization, and had smooth corneal surface. The amnions of 30 cases(86%)were thinning after 2mo, partially dissolved and absorped, not seen with the naked eye after 3mo. Thirty-four cases(97%)had no changes in vision, one case(3%)was from the light to front of the manual. After 2mo, corneal sensation decreased in 30 cases(86%), corneal thickness increased from preoperative 788±35μm to 940±43μm. After 12mo, corneal thickness increased to 1060±27μm. Results of confocal microscopy: after 3mo, the number density of the trigeminal nerve fibers under corneal basement membrane reduced, shallow stromal cells became into fibrotic stroma, deep stroma was more loose, and cells swelled significantly. The number of endothelial cells reduced and form swelled more obviously compared with preoperatively.

CONCLUSION: Corneal acupuncture combined with amniotic membrane transplantation can effectively control the symptoms of BK, prevent the recurrence of BK, and especially it is a simple, safe and practical way for patients with poor visual function.