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Abstrak :
Latar Belakang: Ulkus kornea bakteri merupakan penyebab utama buta kornea. Tatalaksana standar ulkus kornea bakteri hingga kini masih terfokus pada eliminasi infeksi melalui antibiotik. Meskipun amplifikasi bateri telah dihentikan, inflamasi sekunder kornea terus berlangsung dan mengakibatkan destruksi kornea lebih lanjut dan sikatriks yang tebal. Tujuan: Untuk mengevaluasi efektivitas dan keamanan terapi kombinasi keratektomi superfisial dengan transplantasi membran amnion dan plasma autolog topikal pada ulkus kornea bakteri sedang dan berat, dalam memfasilitasi penyembuhan dan meminimalisasi inflamasi sekunder kornea. Metode: Uji klinis terandomisasi terbuka. Pembedahan pada kelompok eksperimental dilakukan dalam 72 jam pasca pemberian tiga hari antibiotik inisial. Hasil: Enambelas mata dengan ulkus kornea bakteri diikutkan dalam penelitian ini. Seluruh ulkus sembuh dalam waktu 36 hari pada kelompok eksperimental, dan 54 hari pada kelompok kontrol. Kecepatan epitelisasi kelompok eksperimental lebih cepat dibandingkan dengan kontrol (1,82±1,11 vs 0,97±0,74 mm2/hari, p=0,04, uji t tidak berpasangan). Terdapat kecenderungan pembentukan sikatriks kornea yang lebih tebal pada kelompok kontrol. Pada akhir evaluasi, tajam penglihatan lebih baik didapatkan pada kelompok eksperimental (0,344 ± 0,15 vs 0,196 ± 0,12 pada ulkus sedang, p=0,2, uji t tidak berpasangan; dan 0,14 ± 0,05 vs 0,014 ± 0,02 pada ulkus berat, p<0,01, uji t tidak berpasangan). Tidak ada komplikasi pada kelompok eksperimental, namun terdapat dua komplikasi pada kelompok kontrol. Simpulan: Terapi kombinasi keratektomi superfisial dengan transplantasi membran amnion dan plasma autolog topikal pada ulkus kornea bakteri terbukti lebih efektif dan aman dibandingkan terapi antibiotik konvensional. Terapi ini mempercepat epitelisasi dan penyembuhan ulkus, sehingga membentuk sikatriks kornea yang lebih tipis dengan tajam penglihatan lebih baik.

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Background: Bacterial corneal ulcer is a leading cause of corneal blindness. Up to now, the standard treatment for bacterial corneal ulcer is limited to the elimination of infection with antibiotic. However, the secondary tissue inflammation may still persist, leading to further corneal tissue destruction and dense corneal scar. Objectives: To evaluate the efficacy and safety of superficial keratectomy, freeze-dried amniotic membrane transplantation and topical autologous plasma as a novel combination therapy in moderate and severe bacterial corneal ulcer, for promoting corneal wound healing and minimizing second injury of the cornea. Methods: An open randomized controlled trial. The operation in experimental group was performed within 72 hours after three days application of initial antibiotic. Results: Sixteen eyes of bacterial corneal ulcers were enrolled. All ulcers were healed within 36 days in the experimental group, compared to 54 days in the control group. Epithelialization rate of the experimental group was significantly faster than the control group (1,82±1,11 vs 0,97±0,74 mm2/day, p=0,04, unpaired t-test). Dense corneal scarring was more likely marked in the control group. Higher visual acuity at the last follow-up was achieved in the experimental group (0,344±0,15 vs 0,196±0,12 for moderate cases, p=0,2, unpaired t-test; and 0,14±0,05 vs 0,014±0,02 for severe cases, p<0,01, unpaired t-test). None complication was found in experimental group, while two complications (impending perforation and limbal damage) were noted within the control group. Conclusions: Combination of superficial keratectomy with amniotic membrane transplantation and topical autologous plasma shows its benefits and safety for bacterial corneal ulcers. It promotes early epithelialization and corneal wound healing, thus achieving less corneal scarring with better visual acuity than conventional antibiotic therapy.

Abstrak :
Proliferation phase is the second of the three phases in wound healing. In this phase, fibroblast is a pivotal component. The migration and proliferation of fibroblasts are influenced by FGF, TGF-β and FGF. Amniotic membrane (AM) which consists of several growth factors that play an important role in wound healing can be used as transplantation materials. This study investigated the influence of AM on the number of fibroblast cells in the process of wound healing on rabbit's gingiva. Thirty six rabbits were divided into 2 groups, one is the control group (C) and the other is the treatment group (I). Each of the groups were divided into 6 groups. composed of 3 rabbits based on the date of termination, i.e. 1st, 3rd, 5th. 7th. 10th and 14th day after wounded. Five layers of AM were applicated on T group wounding and C group wounding were let open. Histological evaluation was done to calculate the number of fibroblast cells. Data analysis was done by using MANOVA. The results showed there was a significant difference (p<0,05) in the number of fibroblast cells between T and C groups among the groups of termination dates. The one having the highest number of fibroblast cell was in T 10 group. lt can be concluded that AM enhanced the number of fibroblast cells in the process of wound healing on rabbit's gingival.