Amniotic Membrane Transplantation versus Tarsorrhaphy for the Treatment of Persistent Corneal Epithelial Defects: A Comparative Study in a Tertiary Eye Care Facility in Riyadh, Saudi Arabia

Background: To evaluate the effectiveness and safety of amniotic membrane transplantation (AMT) compared to tarsorrhaphy for treating persistent corneal epithelial defects (PED) resistant to medical therapy. The primary outcome was complete healing at 1, 2, 3, and 6 months. Secondary outcomes included healing time, recurrence rates, and postoperative complications. Methods: This retrospective study was conducted at King Khaled Eye Specialist Hospital (KKESH), Riyadh, Saudi Arabia. We analyzed electronic medical records of patients treated from January 2018 to December 2021. Patients with PED (epithelial defect > 14 days) receiving either AMT or tarsorrhaphy were included. Data collected included demographics, etiology of PED, size and duration of the PED, type of intervention and postoperative outcomes. Complications assessed included recurrent PED, microbial keratitis, and corneal scarring. Results: Of 67 eyes, 37 underwent AMT (median age 65) and 30 underwent tarsorrhaphy (median age 69). Baseline exposure keratopathy was more prevalent in the tarsorrhaphy group (40% vs. 2.7%; p< 0.001), while microbial keratitis was more common in the AMT group (57% vs. 20%; p=0.002). Healing rates at 1 month were 59% (22/37) for AMT and 50% (15/30) for tarsorrhaphy (p=0.43). By 6 months, healing rates were 86% (32/37) for AMT and 70% (21/30) for tarsorrhaphy (p=0.10). Complications included recurrent PED (2.7% for AMT vs. 6.7% for tarsorrhaphy; p=0.6) and microbial keratitis (2.7% in both groups; p=0.6). Corneal scarring was significantly more frequent in the tarsorrhaphy group (37% vs. 8.1%; p=0.004). Conclusion: Both AMT and tarsorrhaphy successfully facilitated PED healing, with AMT demonstrating a numerically higher, though not statistically significant, healing rate (86% vs 70%). Tarsorrhaphy was associated with a higher incidence of corneal scarring, potentially linked to underlying exposure keratopathy. Future prospective investigations with standardized treatment assignments are warranted. Keywords: persistent epithelial defect, amniotic membrane transplant, tarsorrhaphy, complications