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Ocular surface disorders (OSD) are challenging to treat. They can introduce serious morbidity and might even lead to visual loss. In such situations, keratoplasty remains the last option. Amniotic membrane transplantation (AMT) has been shown to be effective in the management of ocular surface pathologies. The aim of the study was to assess the eff...
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The purpose of this study was to assess the efficacy and safety of the management of severe chemical eye injuries using early keratoplasty combined with limbal autotransplantation and amniotic membrane transplantation. Ten New Zealand white male rabbits were used in the experiment. All procedures followed the rules of ARVO Statement for the Use of...
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The aim of this study was to compare the outcome of conjunctival limbal transplantation with and without the use of amniotic membrane (AM) transplantation for the treatment of limbal deficiency after chemical burns to the eyes.
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Citations
... effects and other concerns related to the management of ocular surface diseases are similar between AMG and medical management in terms of safety profiles. In a study by Thatte [17], patients with various corneal ulcers, chemical burns, and bullous keratopathy experienced significant symptomatic improvement (reduced pain and redness) after receiving AMT. Patients with corneal ulcers also saw enhanced epithelialization and stromal repair. ...
Objective: The aim of the study was to evaluate the effectiveness and safety of freeze-dried amniotic membrane grafting (AMG) and compare it against traditional medical therapy for the management of corneal surface disorders. Methods: A randomized clinical trial was conducted on 60 patients with corneal surface disorders who were randomized equally either into the AMG group (n=30) or medical management group (n=30). Patients in both groups were followed up for 8 weeks after receiving group-specified intervention or till complete resolution (whichever was earlier). Treatment outcome, healing time, improved vision, decreased pain, recurrence rate, and corneal clarity were the main outcome metrics. Results: The most common corneal disorder was persistent epithelial defect (38.33%), closely followed by impending perforated corneal ulcer (31.66%). Majority of the patients (36.66%) had corneal involvement of >75%, while 31.66% had involvement ranging from 50 to 75%. The success rate of AMG (96.7%) was significantly higher than that of medical management (76.7%) in the treatment of corneal surface disorders (p=0.022). During the follow-up period, the incidence of allergic reactions was slightly lower in the AMG group (6.7%) compared to the medical management group (10.0%). Overall, the incidence of side effects and other complications was low in both the AMG group and the medical management group. The severity of side effects was comparable in both the study groups (p=0.886). The recurrence rate of corneal surface disorders in the in the AMG group (6.7%) was statistically lower than that in the medical management group (26.7%) (p=0.037). Conclusion: The findings of the present study supported the use of AMG as an effective and safe alternative to medical management for the treatment of conditions affecting the corneal surface.
... Similar to previous studies, AM was most useful in quick re epithelization of OS in chemical injuries, since the duration of presentation and the surgery is short in these cases. [11][12][13][14] We observed rapid healing with Group 3 (n = 7; 87.5%) next to Group 4 (n = 3; 100.0%) patients. ...
... No major complications were seen. [14] In our study, two patients with severe grade chemical injury had poor OS healing; one eye underwent twice repeat AM surgery. Pérez ML et al. [16] used amniotic membrane extract eye drops in OSD in 50 eyes of 36 patients and achieved overall success of 94.4% of the cases. ...
Purpose
To study the clinical outcomes, time span of healing of various ocular surface disorders with amniotic membrane graft.
Methods
A total of 41 patients, presenting to cornea clinic were included in the study and divided into five groups depending on the type of diagnosis: Group 1, with either >2 weeks of Persistent epithelial defect following cataract/retinal/glaucoma surgeries or Shield ulcers, Group 2 with >4 weeks of Non healing corneal ulcers, Group 3 with chemical injuries, Group 4 with Epithelial defects following keratoplasty, and Group 5 is the miscellaneous group.
Results
The mean age of the study subjects was 50.0 years. Overall mean duration between clinical presentation and AMT was 23.59 (30.7) days, a median 16 days (IQR; 2-26 days). Failure rate was high in Group 5 (n = 3: 30.0%) and Group 2 (n = 3: 27.3%). Time taken for epithelial closure was slower in groups 1 and 5 patients. The average time taken for reabsorption of AMG was 14.98 days. The complications included repeat AMG was in four eyes (9.75%), and graft displacement was noted in four eyes (9.75%) required resuturing, three eyes required TPK (7.31%), and one eye underwent evisceration (2.43%) following severe corneal melt secondary to neurotropic ulcer. The mean log MAR visual acuity improved from 1.52 to 1.26 at the 3 months.
Conclusion
Understanding on timespan for healing of ocular surface disorders with AMG is needed to assess the prognosis of the disease, preoperative counselling for repeat procedures, and the compliance with regard to follow up.
... Тя секретира редица сигнални молекули, като eпидермален растежен фактор (EGF), трансформиращ растежен фактор бета (TGF-β), фибробластен растежен фактор (FGF) и тромбоцитен растежен фактор (PDGF), които подпомагат трофичната функция. Не съдържа HLA -A, B, C антигени и β2-микроглобулин, които биха довели до реакция на отхвърляне (7,8). Всички тези предимства на АМ я правят ...
... It supports the trophic function by secreting several signaling molecules like platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), epidermal growth factor (EGF), and transforming growth factor beta (TGF-β). It does not contain HLA-A, B, and C antigens and β2microglobulin, which would lead to a rejection reaction (7,8). All these advantages of AM make it a polyvalent option for the treatment of various diseases of the anterior ocular surface, such as persistent and recurrent epithelial defects, corneal ulcers, descemetocele, perforations, limbal stem cell insufficiency, symptomatic bullous keratopathy, chemical, and thermal burns, thinning of the sclera, and others (9,10). ...
Introduction: Therapeutic contact lenses (TCLs) are important tools for the treatment of ocular surface diseases and other corneal conditions. The main difference between a normal contact lens and a TCL is that the latter is not controlled by the patient. Aim : The aim of this article is to evaluate the effect of TCLs on amniotic membrane (AM) transplantation and outline the benefits. Materials and Methods: A prospective study was conducted on 30 clinical cases of recurrent erosion syndrome (RES) or superficial corneal trauma collected over one year treated with AM. The study was randomized and 15 of the patients were treated with AM and TCL and 15 with AM alone. Results: Patients treated with AM/TCL rated postoperative comfort with an av. 5.5 (from a scale of 2–6). In comparison, AM patients without TCL rated it 3.5. Twelve of the TCL cases had complete or better epithelialization from day 1, while 5 non-TCL patients had worse results. The study showed AM survived for about 1 week when TCL was included. In the absence of TCL, the membrane lasted less than 48 hours. The most common complications in a period of 7 days were suture rupture (AM&TCL: 1/AM: 8), ruptured membrane (AM&TCL: 2/AM: 12), hemorrhage (AM&TCL: 1/AM: 5), inflammation (AM&TCL: 0/AM: 2), infection (AM&TCL: 0/AM: 1). Conclusion: Therapeutic contact lens placement is a promising method for improving ocular surface health recovery, increases comfort, protects AM, and has long-term outcomes.
... [6][7][8] AM promotes reepithelialization, reduces the formation of scars and new vessels, reduces inflammation, acts as a scaffold for cell growth, contains antimicrobial properties, contains nerve growth factor, and therefore promotes nerve regeneration. [9] AM can be used as grafts, overlays, or multiple layers. In the graft method, only the defect is coated, while in the covering method AM is applied to the entire cornea. ...
PURPOSE: In this study, we aimed to determine amniotic membrane transplantation (AMT) indications, early results and demographic analysis of patients who underwent AMT in our clinic according to age and gender.
METHODS: The records of 154 patients who underwent AMT at the Ophthalmology Clinic between April 2017 and September 2019 were reviewed retrospectively. Examination findings and demographic data of the patients were examined and recorded. Patients were divided into five groups: 0-10 years (Group 1, n=7), 11-20 years (Group 2, n=9), 21-40 years (Group 3, n=23), 41-60 years (Group 4, n=32) and over 60 years (60-89 years) (Group 5, n=83).
RESULTS: Ninety-five (61.7%) of the patients included in the study were male and 59 (38.3%) were female. The mean age of the patients was 55.72 ± 22.53 (Range: 0-89) years. The most common indications for AMT in all age groups were corneal ulcer (n=47, 30.5%), corneal melting (n=32, 20.8%) and persistent epithelial defect (PED) (n=21, 13.6%). The most common age groups for AMT were Group 5 (n=83, 53.9%), Group 4 (n=32, 20.8%) and Group 3 (n=23, 14.9%). The most common indications for AMT in children and adolescents (0-20 years) were corneal ulcer (n=6, 37.5%) and corneal chemical burns (n=5, 31.2%), while in adults over 21 years of age, AMT indications were corneal ulcer (n=41, 29.7%) and corneal melting (n=29, 21.0%).
CONCLUSION: The most common indications for AMT in our study were corneal ulcer, corneal melting and PED. According to the indications, AMT may be a simple and easily applicable surgical method that can be used in the reconstruction of the ocular surface in many corneal and conjunctival pathologies.
... Other maneuvers including conjunctival auto graft [11][12][13] , limbal-conjunctival auto graft [14][15] , conjunctival flap [16][17] , and graft of amniotic membrane [18] have been reported. ...
... AMT versus stromal lenticule in corneal perforation Al Saadany et al 25 cases were successfully sealed, five patients had good AC formation, and only one case needed air injection to reform the collapsed AC [13]. ...
Purpose The aim of this study was to compare the use of femtosecond laser-assisted small-incision corneal stromal lenticule extraction with amniotic membrane (AM) grafting in the management of corneal perforation.
Patients and methods Forty-five eyes with corneal perforation were included in this study after reviewing patients’ records from January 2014 to January 2016. Thirty cases (30 eyes) were treated by AM transplantation and 15 cases (15 eyes) were treated by small-incision corneal stromal lenticule extraction lenticules. The patients were monitored for at least 3 months examining the best-corrected visual acuity, anterior chamber formation, and sealing of the perforation using slit-lamp biomicroscopy. Postoperative complications throughout the follow-up period were recorded.
Results Corneal perforations were successfully sealed in all 45 cases (45 eyes), with insignificant difference between both procedures. During the follow-up period of 3 months, no evidence of infection, relapse or perforation was detected in any patient.
Conclusion Both AM and stromal lenticule grafting seem to be effective initial emergency treatments for corneal perforation in case of corneal graft shortage, with no complications, relapses nor immunological rejection noted throughout the study period.
... 37,73,74 Given these features, human amniotic membrane has been considered useful in several ophthalmic surgeries, including pterygium and other conjunctival diseases. 75 Typically, it must be placed over the bare sclera, with the basement membrane facing up and the stroma facing down. Fibrin glue may be also used to promote amniotic membrane graft fixation to the underlying sclera. ...
The main treatment for pterygium is surgical removal. However, pterygium surgery is concerned with high rates of postoperative recurrence. Predicting factors of recurrence are not fully understood, yet, but they probably depend on a multitude of patient-related, clinical, and/or surgical factors. Several adjuvant treatments have been proposed to reduce postoperative pterygium recurrence, including different antimetabolites, antiangiogenetic factors, and radiation therapy. The purpose of this review is to collect the current evidence regarding application and limits of different therapeutic approaches for preventing postoperative recurrence of pterygium, giving insights and perspectives for better management of this disease. In the light of the current evidence, pterygium surgery cannot disregard wound coverage with conjunctival autografting or rotational flap combined with adjuvant treatments. The rotational flap technique is associated with shorter surgical time rates and prevents graft displacement and necrosis, given its vascular pedicle. Amniotic membrane may still be reserved in case of great conjunctival defects or insufficient conjunctiva. Repeated subconjunctival antivascular endothelial growth factor injections can be considered as an effective and safe adjuvant treatment. Moreover, management of postoperative pain is crucial. Innovative treatment strategies will probably target different molecular pathways, considering recent findings regarding pterygium pathogenesis, to improve better understanding and develop universally shared guidelines. Great importance shall be dedicated to the identification of novel molecular biomarkers and favoring factors of recurrence, in order to achieve a customized surgical treatment for each patient and obtain maximal reduction of postoperative recurrence.
... Moreover, it is important to know that AMT cannot be used to treat ocular disorders related to limbal or conjunctival stem cells, stromal ischemia etc. It cannot also be used for the structural reconstruction of the eye[87]. ...
The aim of this study is to emphasize on the clinical uses of amniotic membrane (AM) in multiple ocular disorders. AM possesses many properties including promotion of epithelialization, anti-fibrotic, anti-apoptotic, anti-angiogenic properties. Epithelial wound healing on the eye surface is promoted due to several epidermal and keratocyte growth factors as well as by its anti-inflammatory and anti-scarring effects due to interleukin-10, interleukin-1 receptor antagonists and inhibition of transforming growth factor- beta (TGF-β) signal transduction by AM in the corneal and conjunctival fibroblasts respectively. It plays a crucial role by functioning as a substitute of basement membrane (BM) and as a temporary graft material. It is not only being used as an eye graft but also its extract can be used as an eye drop for corneal and external eye diseases. So its proper preparation, preservation and clinical application can bring a revolutionary change in the treatment of different ocular disorders.
... Moreover, it is important to know that AMT cannot be used to treat ocular disorders related to limbal or conjunctival stem cells, stromal ischemia etc. It cannot also be used for the structural reconstruction of the eye[87]. ...
The aim of this study is to emphasize on the clinical uses of amniotic membrane (AM) in multiple ocular disorders. AM possesses many properties including promotion of epithelialization, anti-fibrotic, anti-apoptotic, anti-angiogenic properties. Epithelial wound healing on the eye surface is promoted due to several epidermal and keratocyte growth factors as well as by its anti-inflammatory and anti-scarring effects due to interleukin-10, interleukin-1 receptor antagonists and inhibition of transforming growth factor- beta (TGF-β) signal transduction by AM in the corneal and conjunctival fibroblasts respectively. It plays a crucial role by functioning as a substitute of basement membrane (BM) and as a temporary graft material. It is not only being used as an eye graft but also its extract can be used as an eye drop for corneal and external eye diseases. So its proper preparation, preservation and clinical application can bring a revolutionary change in the treatment of different ocular disorders.
... 20 Under strict asepsis, the AM was obtained and used within 24 hours. 21,22 With the connective tissue side facing down, 2 layers of AM were sutured to the palpebral conjunctiva with separate 10-0 nylon sutures. 23 The AM remained on the ocular surface for an average of 5 days, and the rest of AMs were removed on day 7. ...
Purpose:
To compare the effects of collagen cross-linking (CXL) and amniotic membrane transplantation (AMT) on acute corneal alkali burns.
Methods:
After establishment of an alkali burn model, 32 rabbits were divided into 4 groups: control group, AMT group, CXL group, and AMT + CXL (combined) group. Clinical parameters, including epithelial wound, opacity, ulceration, and neovascularization, were evaluated on postinjury days 1, 7, 14, and 18. Histological parameters were examined in hematoxylin/eosin (H&E) and Masson trichrome-stained corneal sections. Immunohistochemical analyses, including a terminal deoxynucleotidyl transferase-mediated biotin-deoxyuridine triphosphate nick-end labeling assay and cluster of differentiation 68 (CD68) labeling, were performed to determine the apoptotic index and macrophage activation.
Results:
On postinjury day 18, the epithelial wound of AMT {4.08% [interquartile range (IQR), 0.68%-5.22%]}, CXL [1.84% (IQR, 0.01%-3.89%)], and combined [3.44% (IQR, 0.01%-4.36%)] groups were significantly lower than the control [15.23% (IQR, 9.86%-23.06%)] group (P = 0.003). No significant difference was detected between the groups in terms of opacity (P = 0.303). Neovascularization was the least severe in the CXL group [16.18% (IQR, 8.39%-21.28%)] and the most severe in the AMT [34.47% (IQR, 17.71%-62.77%)] and combined [35.12% (IQR, 31.96%-59.98%)] groups on day 18 (P = 0.033). Significant increases in the apoptotic index and CD68 labeling were detected in the CXL and combined groups compared with those in the control group (P = 0.047 and P = 0.001, respectively).
Conclusions:
CXL treatment is an effective adjuvant treatment for promoting reepithelialization, reducing inflammation and neovascularization, and preventing ulceration in acute alkali burns. Providing AMT after suppressing inflammation may be a more effective treatment.
