Objective:

To compare the clinical outcomes of amniotic membrane transplantation (AMT) combined with cryotherapy vs. lamellar keratoplasty (LKP) for patients with medically refractory peripheral ulcerative keratitis (PUK), particularly in light of global donor shortages.

Key Findings:

• A total of 58 patients (58 eyes) were included (AMT: n = 28; LKP: n = 30).
• Primary ulcer healing rates were comparable (AMT: 78.6%, LKP: 76.7%; P = 0.862).
• Both groups showed similar BCVA improvements up to 6 months postoperatively.
• LKP demonstrated significantly faster epithelialization (median 6 vs. 12 days; P < 0.05).
• LKP had superior BCVA at 12 months (P = 0.019) and a lower disease recurrence rate (10.0% vs. 32.1%; P = 0.038).
• AMT showed a superior safety profile with no procedure-related complications.

Interpretation:

LKP provides superior long-term optical/structural restoration and a lower recurrence rate compared to AMT, which serves as a safe bridging therapy amid global donor shortages, emphasizing its role in stabilizing the ocular surface.

Limitations:

• Retrospective design may introduce selection bias.
• Limited generalizability due to single-center study.
• Potential confounding factors related to concurrent autoimmune diseases affecting outcomes.

Conclusion:

LKP is the definitive treatment for refractory PUK, while AMT matches LKP in primary healing and mid-term efficacy, highlighting its importance as a bridging therapy in the context of global donor shortages.