Amniotic membrane transplantation for acute chemical or thermal burns

Abstract

In acute burns, amniotic membrane transplantation can be considered as an early, if not immediate, surgical procedure to promote epithelialization and suppress inflammation so that scarring-induced sequelae can be prevented in the chronic stage. % Purpose: To determine whether preserved human amniotic membrane (AM) can be used to treat ocular burns in the acute stage. Design Prospective, noncomparative, interventional case series. Participants Thirteen eyes from 11 patients with acute burns, 10 eyes with chemical burns and 3 with thermal burns of grades II–III (7 eyes) and grade IV (6 eyes), treated at 7 different facilities. Methods Patients received amniotic membrane transplantation (AMT) within 2 weeks after the injury. Main outcome measures Integrity of ocular surface epithelium and visual acuity during 9 months of follow-up. Results Ten patients were male and one patient was female; most were young (38.2 ± 10.6 years). For a follow-up of 8.8 + 4.7 months, 11 of 13 eyes (84.63%) showed epithelialization within 2 to 5 weeks (23.7 ± 9.8 days), and final visual acuity improved ≥6 lines (6 eyes), 4 to 5 lines (2 eyes), and 1 to 3 lines (2 eyes); only one eye experienced a symblepharon. Eyes with burns of grade II to III showed more visual improvement (7.3 ± 3 lines) than those with burns of grade IV (2.3 ± 3.0 lines; P < 0.05, unpaired t test). In the group with grade II or III burns, none had limbal stem cell deficiency. All eyes in the group with grade IV burns did experience limbal stem cell deficiency. Conclusions Amniotic membrane transplantation is effective in promoting re-epithelialization and reducing inflammation, thus preventing scarring sequelae in the late stage. In mild to moderate burns, AMT alone rapidly restores both corneal and conjunctival surfaces. In severe burns, however, it restores the conjunctival ocular surface without debilitating symblepharon and reduces limbal stromal inflammation, but does not prevent limbal stem cell deficiency, which requires further limbal stem cell transplantation. These results underscore the importance of immediate intervention in the acute stage of eyes with severely damaged ocular surface. Further prospective randomized studies including a control group are required to determine the effectiveness of AMT in acute chemical and thermal burns of the eye.