Amniotic Membrane Implantation Research Articles

CASE REPORT: “Boston type I keratoprosthesis with buccal mucosal overlay in severe chemical burn” ‘Barcelona CP’

Objective To describe a case of severe chemical burn treated with a novel Boston type I keratoprosthesis (B1-KPro) technique. Methods We present the case of a 25-year-old woman with poor light perception in both eyes who had bilateral chemical burn with caustic soda 3 months earlier. She underwent several amniotic membrane implants and subconjunctival triamcinolone injections without significant improvement. We decided to perform a two-stage surgery on the right eye (RE). Reconstruction of the ocular surface was first performed using a buccal mucosa allograft. Nine months later the second surgical stage was performed, which consisted of partial lifting of the buccal mucosa, B1-KPro implantation covered with the buccal mucosa overlay and exposing the optics of the keratoprosthesis. Results Two days following surgery the uncorrected visual acuity (UCVA) was +0.2 logMAR. Best-corrected visual acuity (BCVA) at one month was 0,0 logMAR, remaining stable after one year and eleven months of follow-up. Conclusions Boston type 1 keratoprosthesis covered with buccal mucosa (B1-KPro with mucosa overlay technique) could be considered an alternative in severe ocular chemical burn with marked shortening of the fornix, as an alternative to osteo-odonto-keratoprosthesis (OOKP) or tibial bone keratoprosthesis or when the Boston type II keratoprosthesis is not available. It allows restoration of the anatomy and condition of the ocular surface using autologous tissue, with better aesthetics than OOKP and material easily available as it has the CE marking.

Функциональная и морфологическая эффективность хирургического лечения разрывов макулы различной этиологии путем имплантации амниотической мембраны

The aim of the study was to evaluate the effectiveness of amniotic membrane implantation in macula ruptures. The study included 86 eyes with a macular tear greater than 400 µm. The technique of implantation of the amniotic membrane in case of macular ruptures provides anatomical success in 96.51 % of cases and functional success in 91.86 % of cases. Macular rupture as a complication of vitreomacular traction syndrome was the least favorable prognostic situation compared to traumatic (p < 0.01) and myopic ruptures (p < 0.05). Keywords: macular rupture, vitreoretinal surgery, amniotic membrane, anatomical and functional success

DEGENERATIVE ARTICULAR CARTILAGE DISEASE, OSTEOARTHROSIS

Introduction: Osteoarthrosis (OA), degenerative articular cartilage disease is a chronic inflammatory arthropathy involving joint elements (subchondral bone, synovial membrane, hyaline cartilage and others). It is due to a disorder in the regulation between degradation and synthesis of the extracellular matrix of cartilage, involving bone and synovial membrane in a biochemical process mediated by growth factors and cytokines which, in turn, intervene in the course of bone remodeling and joint destruction. Objective: to detail the current information related to osteoarthrosis, description, etiology, classification, imaging classification, management and current treatments. Methodology: a total of 52 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 38 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: arthrosis, osteoartrose, bones, osteoartrosis, articular cartilage. Results: The prevalence of osteoarthrosis increases directly with age 25-35 years 0.1 % 35-65 years 30 % and over 80 years 80-100 %. An improvement of pain and sensitivity is observed with local treatment with capsaicin. Paracetamol can be considered as the basic analgesic in the treatment of most chronic osteoarticular pain in doses of 1 gram four times/day. Opioids have an analgesic effect that almost completely eliminates all kinds of pain regardless of its intensity or site of affection. Short-term and long-term parenteral corticosteroid use is effective in controlling pain and stiffness. Systemic use of corticosteroids in OA is not warranted and only intra-articular injections are advised. Diacerein decreases IL 1Beta production in cartilage as well as nitric oxide levels by antagonizing the catabolic process and stimulates the anabolic process of cartilage. Chondroitin sulfate does not present a clinically relevant effect on joint pain or joint space reduction. Conclusions: osteoarthritis should be considered as a chronic, irreversible and progressive lesion. There are factors that aggravate its prognosis. Many measures are recommended to the patient and his family, especially if it is an elderly patient, in order to avoid the progression of joint damage. Surgical treatment is reserved for patients with severe pain or marked deformity, which occurs in advanced OA. Among the most frequently used procedures are: valgus osteotomy of the proximal tibia, arthroplasty, arthrodesis and amniotic membrane implantation. Bone tissue regenerative currents using tetracyclines that prevent the activation of metalloproteases, autologous chondrocyte implants, hypoxia inducible factor (HIF-1/2a), parathyroid hormone that stimulates chondrocyte multiplication and the use of in situ stem cells, cartilage regeneration and a better understanding of the developmental protein ancestor of osteogenesis, will be part of the medical management protocol, being a promising therapy for future therapy. KEY WORDS: Osteoarthrosis, osteoartrose, bones, osteoartrosis, articular cartilage.

Use of Sutureless Dehydrated Amniotic Membrane to Treat Corneal Scares (About A Case)

The human amniotic membrane has been known to help treat a variety of ocular surface diseases thanks to its different components and properties. The amniotic membrane implantation needed the use of sutures or glue in an operating room. Nowadays, the introduction of in-office sutureless amniotic membranes has made it simpler and easier for practicians to use amniotic membranes in their daily practice. Dehydrated amniotic membrane is a type of in-office sutureless membrane that doesn't need much preparation nor time and with the same efficiency as the other types of amniotic membranes. We present the case where we used a sutureless dehydrated amniotic membrane to treat difficult corneal opacities on a teenager's eye.

Anal Fistula Human Amniotic Membrane Endosealing (F-HAME): A Proof of Concept Study.

The treatment of cryptoglandular anal fistula (AF) is often a challenge for surgeons. Several sphincter-saving procedures have been described as an alternative to fistulotomy, with the common goal of promoting healing and preserve anal continence. The aim of this proof of concept study was to assess the outcomes of human amniotic membrane (HAM) implantation in cryptoglandular transphincteric AF. Two consecutive female were recruited. The primary outcome was clinical healing at 6 months. Secondary outcomes were ultrasonographic healing, complications and reinterventions, AF symptoms, fecal incontinence, psychological impact of treatment, recurrence, development of additional AF, patient satisfaction, and quality of life, as measured using validated questionnaires. Both patients (40 and 54-year-old) previously underwent incision and drainage of anal abscess with concomitant seton placement. HAM implantation was performed as a day case under local anesthesia. No intra- or post-procedural complications occurred. Clinical and radiological healing were not achieved at 6 months. However, the external outlet discharge diminished through time, with sustained improvements in quality of life. Clinical healing occurred at 7 months in both patients. Psychological impact of treatment and patient satisfaction were overall good, with improvements in the PHQ-9, GAD-7, and Short Assessment of Patients Satisfaction. HAM implantation is safe and improves patients' quality of life, progressively leading to clinical healing. Future studies are needed to assess its safety in other etiology of AF.

Feasibility and Safety of Amniotic Membrane Implantation in High-Risk Pancreatic Anastomosis: A Prospective Study

Introduction: Due to its unique biological properties, amniotic membrane (AM) implantation is effective in tissue regeneration and fluid leakage prevention. Accordingly, AM may preserve the integrity of pancreatic anastomoses.

Combined Platelet Rich Plasma and Amniotic membrane in the treatment of Perforated Corneal Ulcers.

To report the outcomes of using synthetic amniotic membrane with platelet rich plasma for the primary management of corneal perforations. Ophthalmology department. Faculty of Medicine, Minia University, Minia, Egypt. A case series of 10 patients diagnosed with corneal perforation underwent emergency surgical procedure for repair of the perforation through the implantation of synthetic amniotic membrane with platelet-rich plasma clot under it and the application of platelet-rich plasma eye drops, with a follow up period of up to 4 weeks. All cases demonstrated formation of adequate intraocular pressure digitally, within the first 7 days, and all cases showed complete sealing of the corneal perforation within the 4 weeks follow up period, mild symptoms were reported only in the 1st postoperative week like foreign body sensation and lacrimation. 3 of the treated patients underwent penetrating keratoplasty after 6 months with satisfactory visual outcomes. The combination of amniotic membrane implant and platelet rich plasma in both the clot and eye drop forms is an effective and easy accessible method for the primary management of corneal perforations.

Amniotic Membrane over Pancreatic Anastomosis after High Risk Pancreaticoduodenectomy: Preliminary Experience of a Prospective Study

Introduction: Relevant pancreatic fistula(CR-POPF) after pancreatic resection is a life-threatening complication. None of the existing strategies is effective in reducing its incidence. Many studies suggest that amniotic membrane (AM) is effective in tissue regeneration and prevention of fluid leakage at many surgical sites.We reported the first case of AM implantation after pancreaticoduodenectomy(PD).

Human Amniotic Membrane Plug to Restore Age-Related Macular Degeneration Photoreceptor Damage

Age-related macular degeneration (AMD) is the leading cause of legal blindness in adults 65 years of age and older. Choroidal neovascularization (CNV) can complicate AMD and lead to severe visual acuity reduction. Despite the several treatments available, if the retinal pigment epithelium is damaged, we have to cope with the impossibility of restoring acceptable visual acuity using only medical treatments. Prospective, consecutive, interventional study. Eleven patients affected by AMD, 6 patients affected by CNV, and 5 patients affected by geographic atrophy. All patients underwent a pars plana vitrectomy with subretinal implantation of human amniotic membrane (hAM) to induce photoreceptor regeneration and partial visual acuity restoration. Primary study outcome was visual acuity improvement. Secondary outcomes were multimodal imaging results. Mean preoperative best-corrected visual acuity (BCVA) was 20/2000 (2 logarithm of the minimum angle of resolution [logMAR]), and all the patients showed a BCVA of counting fingers or less. Mean final BCVA was 20/400 (1.31 logMAR), ranging from 20/2000 to 20/100 (2-0.7 logMAR). OCT angiography was used to measure retinal vascularization in the treated eye compared with the fellow eye. A high correlation between BCVA and deep vascular density was evidenced. Adaptive optics findings, obtained over the retinal area where the highest functionality was observed, were evaluated using microperimetry. The images showed possible photoreceptor presence over the hAM membrane. This work supports the feasibility and safety of the hAM to promote partial retinal function restoration 6 months after surgery with visual acuity improvement. The advanced diagnostics help to understand the interaction between the hAM and photoreceptors and suggest that photoreceptor regeneration may occur.

Clinical Aspects of Amniotic Membrane Implants in Corneal Repair in Dogs with Complicated Ulcers

Background: Among numerous disorders treated by veterinary ophthalmology, therapies employed to solve corneal ulcers stand out. Amniotic membrane transplantation is an effective surgical technique for the treatment of complicated corneal ulcers in the dog, with highly satisfactory visual and cosmetic outcomes. However, in veterinary ophthalmology, reports on the use of the amniotic membrane and its corneal reconstructive potential are scarce. The objective of this work was to evaluate, for 21 days, the clinical aspects and the effectiveness of transplantation of canine amniotic membrane for corneal healing in two cases of complicated ulcers in dogs.Cases: Two Shih-Tzu dogs were diagnosed with complicated corneal ulcer. They underwent surgical treatment with the use of a glycerin-preserved canine amniotic membrane implant, which was secured on the cornea or the limbus. A surgical microscope at a magnification of 16x was used. The devitalized tissues at the periphery of the ulcer were excised, and multiple layers of amniotic membranes were sutured onto the cornea and near the limbus with interrupted absorbable suture. Protection of the canine amniotic membrane implants was performed with a scarified third eyelid flap, which was attached to the upper eyelid, and maintained for 14 days. During the first 14 days after the procedure, topical treatment with antibiotic eye drops was administered; protease inhibitors were also used. Antibiotics were used systemically for 10 days. Between days 14 and 21 after the transplantation procedure, protease inhibitors, corticosteroids, and lubricant were administered topically. Healing and clinical aspects were evaluated on days 0, 14, and 21. The parameters evaluated were blepharospasm, dazzle and direct pupillary reflexes, and consensual and threat responses. Corneal vascularization, hypopyon, synechia, opacity, and fluorescein dye penetration into the cornea were evaluated. The patient whose membrane was attached to the cornea was named COr, and the animal whose membrane was attached to the corneal limbus was named PLi. Blepharospasm and positive fluorescein test were detected only on the first day of the experiment; whereas, the dazzle and pupillary reflexes, as well as the consensual response, were present in both animals at all evaluated time points. Only COr exhibited hypopyon on day 0. Synechia was not observed in any of the animals at any of the time points. On the 21st day, COr exhibited deep vascularization and an opaque scar, while PLi exhibited only discrete vessels without blood perfusion, secondary to corneal repair.Discussion: A smooth operation of the central and peripheral ophthalmic system was maintained at all periods evaluated. The protection provided by the membrane contributed to corneal healing by reducing stimulation of nerve endings on the epithelium and stroma, and suppressing the blepharospasm reflex. The amniotic membrane used as an adjuvant has antimicrobial and anti-inflammatory properties, inhibits proteinases and mediators of inflammation, and exerts a mechanically protective effect. The corneal vascularization observed in both animals is related to the healing processes stimulated by filling the deep corneal lesions with the membrane. When used in addition to drug therapy, the amniotic membrane can inhibit postinflammatory neovascularization, fibroblast activity, collagen deposition, scarring, and opacifications. Accurate diagnosis, and correct therapeutic and surgical management, is fundamental for the successful treatment of corneal ulcers. In this work, canine amniotic membrane preserved in glycerin was used for the surgical treatment of complicated ulcers in dogs along with adequate clinical therapy. This was effective independent of the different anchorage techniques used, and led to satisfactory clinical results and short-term corneal healing.

First case of implantation of amniotic membrane over pancreatic anastomosis after pancreaticoduodenectomy.

First case of implantation of amniotic membrane over pancreatic anastomosis after pancreaticoduodenectomy.

Role of interferon alpha 2b (IFN‐α2b) in the treatment of conjunctive squamous neoplasia

AbstractPurposeIFN‐α2b has been postulated as an effective treatment to treat ocular surface tumors since the mid‐1990s. It could be used as a neoadjuvant agent, adjuvant therapy if there are positive margins after resection or as a primary agent for small tumors. It causes anti‐angiogenic, anti‐proliferative, cytotoxic and immunomodulatory effects. Consequently, it reduces the number of recurrences with few and mild side effects.MethodsWe present the case of a 77‐year‐old man with history of right eye cataract surgery who was seen in our Ophthalmology Department, due to a new appearance of a conjunctival tumor in the upper and lower temporal sectors, arriving at the bulbar conjunctiva with corneal invasion in the right eye. After performing a biopsy, squamous cell carcinoma with mild dysplasia was diagnosed. Ultrasonography and MRI were requested, ruling out infiltration. Surgical excision and amniotic membrane implantation were decided. Despite starting treatment with mitomycin C (MMC) 4 times a day, he suffered from a temporary recurrence. A second excision was performed 3 months later. This time, treatment with IFN‐α2b was started 4 times a day.ResultsIFN‐α2b is consolidating as a postoperative adjuvant treatment. In our case, it has managed to avoid new recurrences. We observed an asymmetric rise of the intraocular pressure (IOP) which could be associated with IFN‐α2b and need antihypertensive ocular topic treatment.ConclusionNowadays, surgery remains the gold standard in the treatment of these tumors. Nevertheless, the high rate of recurrences and the appearance of different treatments makes search for an optimized treatment of these patients possible and necessary. IFN‐α2b stands out in terms of cost‐effectiveness and must be present among the therapeutic arsenal of any ophthalmologist who faces this carcinoma but it side effects should be studied.

Clinical effect of P50 EX-PRESS drainage nail combined with biological amniotic membrane implantation in the treatment of POAG

Clinical effect of P50 EX-PRESS drainage nail combined with biological amniotic membrane implantation in the treatment of POAG

Prospective Study on Implantation of Amniotic Membrane (AM) Over Pancreatic Anastomosis After Pancreaticoduodenenctomy: Efficacy on Preventing Clinically Relevant Pancreatic Fistula

Prospective Study on Implantation of Amniotic Membrane (AM) Over Pancreatic Anastomosis After Pancreaticoduodenenctomy: Efficacy on Preventing Clinically Relevant Pancreatic Fistula

Human acellular amniotic membrane implantation for lower third nasal reconstruction: a promising therapy to promote wound healing

BackgroundThe lower third of the nose is one of the most important cosmetic units of the face, and its reconstructive techniques remain a big challenge. As an alternative approach to repair or regenerate the nasal tissue, the biomaterial-based strategy has been extensively investigated. The aim of this study is to determine the safety and efficacy of human acellular amniotic membrane (HAAM) to repair the full-thickness defects in the lower third of the nose in humans.MethodsIn this study, 180 patients who underwent excision of skin lesions of the lower third of the nose from 2012 to 2016 were included; of the patients, 92 received HAAM and Vaseline gauze treatments, and the other 88 patients received Vaseline gauze treatment only. The haemostasis time and the duration of operation were recorded during surgery; after surgery, the time to pain disappearance, scab formation and wound healing, and the wound healing rate were measured.ResultsImmediately after the HAAM implantation, a reduction of the haemostasis time and an accelerated disappearance of pain were observed. Compared with the control group, the formation and detachment of scab in patients who received the HAAM implantation were notably accelerated, postoperatively. When the diameter of the lesion exceeded 5 mm, the HAAM implantation was found to enhance the wound healing, although this enhancement was not seen when the diameter was less than 5 mm. Additionally, the HAAM implantation significantly reduced bleeding, wound infection and scar formation, postoperatively.ConclusionsHAAM-assisted healing is a promising therapy for lower third nasal reconstruction leading to rapid wound healing and fewer complications and thus has considerable potential for extensive clinical application in repairing skin wounds.Trial registrationChiCTR1800017618, retrospectively registered on July 08, 2018.

Amniotic membrane application in complex cases of penetrating keratoplasty surgery

INTRODUCTION. The aim of the study is to investigate the ability of an amniotic membrane implant combined with penetrating keratoplasty to reduce early and mid-term complications in complex cases such as penetrating burns, infective ulcers, keratitis, or corneal graft failure. MATERIALS AND METHODS. Fifty patients: 12 with keratitis, 24 with infective ulcers, 10 with penetrating trauma, and four with a history of corneal graft failure, were divided into two groups. The first group of 25 patients (Group A) underwent penetrating keratoplasty alone, while the second group of 25 patients (Group B) received penetrating keratoplasty associated with an amniotic membrane implant. Amniotic membrane implantation was performed in a ‘patch modality’, and the membrane was sewn to the graft with the epithelium/basement membrane side facing inwards. All patients were evaluated, respectively, 3, 15, 30, 90, and 180 days after surgery. At each visit a slit-lamp examination was performed together with corneal thickness and endothelial cell count assessment. All the data were subjected to statistical analysis with Student’s t-test. RESULTS. At the slit-lamp examination in Group A 48% of patients showed Descemet folds at one and three months, respectively, while 80% of patients of Group B did not show any Descemet folds. In Group A we registered two cases of early graft failure and two cases of shallow anterior chamber, while none of these complications appeared in Group B. In Group A the average corneal thickness at 15, 30, 90, and 180 days post-operatively was, respectively, 695 ± 43 μm, 658 ± 31 μm, 588 ± 12 μm, and 518 ± 20 μm, while in Group B it was found to be, respectively, 667 ± 12 μm, 632 ± 17 μm, 562 ± 16 μm, and 516 ± 10 μm. Differences in corneal thickness between Group A and Group B were found to be statistically significant (p = 0.05). Endothelial cell count was in Group A 2582 c/mm2 at 15 days, 2500 c/mm2 at one month, 2335 c/mm2 at three months, and 2111 c/mm2 at six months, while the average count for Group B patients was 2607 c/mm2, 2503 c/mm2, 2299 c/mm2, and 2086 c/mm2, respectively. Differences in endothelial cell count between the two groups did not show any statistical significance (p > 0.05). CONCLUSIONS. Amniotic membrane implantation associated with penetrating keratoplasty reduces early and mid-term complications of corneal grafts in patients with high risk of failure. This positive effect may be due to the anti-inflammatory, neurotrophic, and anti-angiogenetic properties of the amniotic membrane. Longer observation and larger case series can be useful in evaluation of the functional outcome of grafts in these patients.

Curative effect of scleral slap invagination and trabeculectomy with amniotic membrane implantation in the treatment of glaucoma

Curative effect of scleral slap invagination and trabeculectomy with amniotic membrane implantation in the treatment of glaucoma

Safety and Efficacy of Amniotic Membrane Implant in Venous Leg Ulcers

Objective: To assess the safety and efficacy of amniotic membrane (AM) application in venous leg ulcers (VLU). Methodology: Design: non-controlled pre-post clinical trial. A unique AM fragment was placed on the ulcer in strict sterility conditions. Main outcome measures: total healing rate, percentage of ulcer area reduction and diurnal and nocturnal pain assessment. Control visits: at baseline and 1, 2, 3, 4 and 8 weeks after treatment. Results: Ten patients were recruited (79.6 years). 3 weeks after AM implant, pain had completely disappeared and ulcer area had reduced to nearly halved and, 8 weeks after AM implant, ulcer area was reduced in more than 80% and in two thirds of patients the ulcer was completely healed. No relevant side effects were observed. Conclusions: The present study brings new evidence reinforcing the idea that AM dressing is a safety and effective alternative to heal VLU

Effect and safety of EX-PRESS shunt implantation combined with biological amniotic membrane implantation for primary open angle glaucoma

Effect and safety of EX-PRESS shunt implantation combined with biological amniotic membrane implantation for primary open angle glaucoma

Phacoemulsification combined with deep sclerectomy augmented with mitomycin and amniotic membrane implantation in chronic primary open angle glaucoma with cataract.

ObjectiveThe aim of this study was to determine the safety and efficacy of combined phacoemulsification plus Intraocular lens (IOL) implantation with deep sclerectomy augmented with mitomycin C (MMC) and sub-flap implantation of amniotic membrane for the management of uncontrolled, chronic, primary open-angle glaucoma patients.MethodsThis prospective study included 41 patients with chronic, primary, open-angle glaucoma and cataract uncontrolled with medical treatment who underwent combined phacoemulsification augmented with mitomycin C (MMC) application and amniotic membrane implantation under the scleral flap. Intraocular pressure (IOP), visual acuity, glaucoma medications, stabilization of visual field, complications, and viability of the success rate were assessed a 36-month follow-up period.ResultsThe mean age of cases was 54.8 ± 5.3 years. Sixty-one percent of cases were males, and 39% were females. The mean IOP decreased from 23.8 ± 1.8 mmHg preoperatively to 16.8 ± 2.3 mmHg postoperatively. The overall success rate was 97.5, 95, and 92.7% in the first, second, and third year, respectively. The overall success rate was 90% in the first year, but that decreased to 85.3 and 78% in the second and third year, respectively. Qualified success was 7.5, 10, and 14.7% in the first, second, and third year, respectively. Failure was recorded as 2.5, 5, and 7.3% in the first, second, and third year, respectively. IOP reduction was sustained through the follow-up period. Visual acuity improved from 0.13 ± 0.06 to 0.9 ± 0.07 (p < 0.001). The visual field improved significantly in the first assessment, from 14.0 ± 2.7 preoperatively to 12.6 ± 2.6 at three months postoperatively (p < 0.001), after which it became stable for the remainder of the follow-up period. One hundred percent of cases were on three anti-glaucoma drugs preoperatively, while postoperatively, 12.2% were on three drugs, 4.2% were on two drugs, and 82.9% were controlled without anti-glaucoma treatment. There were minor postoperative complications all of which were minor, such as a spike in the post-operative IOP and the formation of fibrinous material in the anterior chamber, both of which were treated medically without any adverse effects on the final results.ConclusionAmniotic membrane implantation in conjunction with MMC application may be an effective alternative to expensive implants in deep sclerectomy combined with phacoemulsification, and this approach can be used safely in advanced cases.