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Bullous keratopathy (BK) is a pathological condition characterized by the corneal thickening, loss of transparency and creation of small vesicles (bullas) on the cornea due to loss of corneal endothelial function.
Predisposing conditions for the development of BK is very advanced stage of Fuchs endothelial dystrophy, long duration and possible complications during cataract surgery during which permanent and irreversible damage to endothelial cells have occurred.
Clinically BK presents itself with reduced visual acuity, foreign body sensation, pain, redness and tearing eyes. Diagnosis is made by examination under biomicroscope where it is possible to see swollen cornea with reduced transparency and bullous formations in the epitheliaum. Measuring the thickness of the cornea with optical coherence tomography and endothelial cell count is performed to confirm clinical examination.
In the treatment lubricating eye drops are used, as well as therapeutic soft contact lenses and/or transplantation of the amniotic membrane in order to alleviate the pain and protect the exposed nerve endings. The exact mechanism of the beneficial effect of the amniotic membrane is not known, however it was proved that TAM enhances the healing of the epithelium as it serves as a membrane for epithelial cell growth, it prevents the infiltration of inflammatory cells and reduces apoptosis of keratinocytes. Posterior lamellar transplantation done in most patients as final method of treatment. If BK persists for a long time and changes in all corneal layer develop then penetrating transplantation is indicated.