Amniotic Membrane Transplantation For Treatment Research Articles

Outcomes of Ipsilateral Simple Limbal Epithelial Transplantation, Tenonectomy, Mitomycin and Amniotic Membrane Transplantation for Treatment of Recurrent Pterygium.

To report on the outcomes of recurrent pterygium treated by ipsilateral simple limbal epithelial transplantation (SLET), mitomycin, tenonectomy, and amniotic membrane transplantation. A retrospective, interventional study was conducted including all patients with recurrent pterygium who underwent SLET surgery under a single surgeon using ipsilateral donor tissue with a minimum 6-month follow-up at Toronto Western Hospital, Canada. Outcome measures included the following: recurrence rates, best spectacle-corrected visual acuity, and postoperative complications. Ten eyes of 10 patients, aged 60.7 ± 18.5 years (range 23-79) with a mean follow-up time of 15.2 ± 10.0 months of which 50% (n = 5) were men, were included. Eight eyes (80%) had a history of 2 or less pterygium operations. Two patients had 3 and 5 previous pterygium operations, respectively. Concurrent limbal stem cell disease was noted in 6 eyes (60%). Average number of pterygium recurrences per eye was 1.9 ± 1.3 (range 1-5). Mean pre-op best-corrected visual acuity was 0.5 LogMAR (Snellen equivalent 20/60, range 20/20 to counting fingers). Best-corrected visual acuity remained the same or improved in 6 eyes (60%). Recurrence was noted in 1 eye (10%) with a history of 5 previous pterygium excisions and remained stable at the last follow-up. No patients required a second operation. Ipsilateral SLET with mitomycin, tenonectomy, and amniotic membrane transplantation is a novel technique to address recurrent pterygium. Concurrent limbal stem cell diseases are often present. Initial results demonstrate low recurrence. Visual improvement is modest. Stabilization of the ocular surface to improve vision is possible.

Comparison between limbal stem cell versus dry amniotic membrane transplantation in treatment of primary pterygium

Abstract Background Pterygium is a degenerative disorder of the conjunctiva which leads to encroachment of bulbar conjunctiva onto the cornea. This invasion causes irritation of ocular surface, irregular astigmatism and loss of visual acuity.surgical treatment of pterygium is directrd towards excision, prevention of recurrence and restoration of ocular surface integrity. A myriad of techniques have been described for achieving these goals. Tha main complication of these procedures is the recurrence rate, which has been estimated as high as 30%_70%. Purpose to compare the efficiency of limbal stem cell transplantation versus dry amniotic membrane transplantation in treatment of pterygium. Patients and Methods The study carried out at ophthalmology department, Ain shams university and included 20 eyes which were classified into two groups; first group included 10 eyes of patients underwent pterygium excision with amniotic membrane transplantation. Second group included 10 eyes of patients underwent pterygium excision with limbal stem cell transplantation. Results the mean follow up duration was 1-3 months in both groups. On comparing recurrence rate between the studied groups which occurred only in the first group in two eyes 20%, there is no statistically significant difference found between the studied groups as regard recurrence. But it was statistically significant better with limbal conjunctival autografting. Graft rejection was not detected in the two groups during follow up period. There was no statistically significant difference found between the studied groups as regard clinical stability and graft rejection. Conclusion Limbal stem cell transplantation proved to be better than amniotic membrane transplantation in treatment of pterygium. As it is more effective in prevention of pterygium reccurence as well as it is of lower cost and better availability than amniotic membrane.

A multicenter retrospective study on cryopreserved amniotic membrane transplantation for the treatment of complicated corneal ulcers in the dog.

To describe the surgical technique and outcome of amniotic membrane transplantation (AMT) for treatment of complicated corneal ulcers in dogs. One hundred and eleven dogs. Medical records (2010-2017) were reviewed to identify canine patients that underwent AMT for the treatment of complicated corneal ulcers. Quantitative and ordinal variables were analyzed using Mann-Whitney U test and Fisher's Exact test. Brachycephalic breeds were overrepresented (74/111; 66.6%). Three dogs were bilaterally affected. Fifty-one had melting ulcers (51/114; 44.7%), 33 stromal ulcers (33/63; 52.4%), 17 descemetoceles (17/63; 27%), and 13 perforations (13/63;20.6%). Mean defect size was 6.2mm (2-18mm). Human (32/114; 28.1%) or bovine (82/114; 71.9%) (AmnioVet(R)) cryopreserved amniotic membranes were used. Monolayer (31/114; 27.2%), bilayer (44/114; 38.6%) or multilayer technique (39/114; 34.2%) was performed, being anchored to the limbus (52/114; 45.6%), to the defect (48/114; 42.1%) or both (14/114; 12.3%). Mean epithelial healing and follow-up times were 25.6days (15-45) and 98.7days (21-400), respectively. Most common postsurgical complications included pigmentation (10/114; 8.8%) and graft failure (5/114; 4.4%). Depth and size of corneal lesions, human amniotic membrane (AM) and concurrent ocular diseases were associated with more complications (P<0.05). Good cosmetic and visual outcomes were achieved in 99.1% (113/114) and 97.4% (111/114) of cases, respectively. Zero to low graft opacity was seen in 23.9% of the eyes (27/113), mild to moderate in 64.6% (73/113) and complete in 11.5% (13/113). Cryopreserved AMT is an effective surgical technique for the treatment of complicated corneal ulcers in the dog, with highly satisfactory visual and cosmetic outcomes.

A randomized clinical trial to evaluate the usefulness of amniotic membrane transplantation in bacterial keratitis healing

PurposeTo determine whether early amniotic membrane transplantation improves the outcomes among patients with bacterial keratitis. Patients and methodsIn this prospective randomized clinical trial 49 eyes from 49 patients with bacterial keratitis received routine antibiotic therapy followed by double-layer amniotic membrane transplantation during 2–5 days after start up of the medications and the second group of 50 eyes from 50 patients only received routine antibacterial therapy. The main outcomes including visual acuity, corneal healing time, scar size, hypopyon size and duration as well as the depth of corneal opacity and neovascularization were followed for a six months period. In addition, Langerhans cells density and tectonic procedures were documented during the healing period. ResultsOur results indicated statistically significant better best corrected visual acuity (p < 0.001), uncorrected visual acuity (p < 0.001), as well as contact lens corrected visual acuity (p < 0.001) at six months in the case group compared to control group. Corneal healing time, the depth of corneal opacity, hypopyon size and duration were not significantly different in the case group while the scar size (p < 0.001) was significantly smaller. Also significantly less corneal vascularization at six months (p < 0.001) and Langerhans cells density (p < 0.001) at one month were observed in the case group. ConclusionThe early use of amniotic membrane transplantation in treatment of patients with bacterial keratitis was associated with better outcomes compared to antibiotic therapy alone. More comparative studies to investigate the probable side effects as well as the cost benefit of this method are needed.

Outcomes of amniotic membrane transplantation for treatment of Stevens-Johnson syndrome in the pediatric population: a retrospective review

Outcomes of amniotic membrane transplantation for treatment of Stevens-Johnson syndrome in the pediatric population: a retrospective review

Active Pedicle Epithelial Flap Transposition Combined with Amniotic Membrane Transplantation for Treatment of Nonhealing Corneal Ulcers.

Introduction. The objective was to evaluate the efficacy of active pedicle epithelial flap transposition combined with amniotic membrane transplantation (AMT) in treating nonhealing corneal ulcers. Material and Methods. Eleven patients (11 eyes) with nonhealing corneal ulcer who underwent the combined surgery were included. Postoperatively, ulcer healing time was detected by corneal fluorescein staining. Visual acuity, intraocular pressure, surgical complications, and recurrence were recorded. Corneal status was inspected by the laser scanning confocal microscopy and anterior segment optical coherence tomography (AS-OCT). Results. The primary diseases were herpes simplex keratitis (8 eyes), corneal graft ulcer (2 eyes), and Stevens-Johnson syndrome (1 eye). All epithelial flaps were intact following surgery, without shedding or displacement. Mean ulcer healing time was 10.8 ± 3.1 days, with a healing rate of 91%. Vision significantly improved from 1.70 to 0.82 log MAR (P = 0.001). A significant decrease in inflammatory cell infiltration and corneal stromal edema was revealed 2 months postoperatively by confocal microscopy and AS-OCT. Corneal ulcer recurred in 1 eye. None of the patients developed major complications. Conclusion. Active pedicle epithelial flap transposition combined with AMT is a simple and effective treatment for nonhealing corneal ulcers.

Toxic keratopathy associated with abuse of topical anesthetics and amniotic membrane transplantation for treatment.

To evaluate the clinical findings of toxic keratopathy associated with abuse of topical anesthetics and the treatment efficacy of amniotic membrane transplantation (AMT). Fifteen eyes of 10 patients with abuse of topical anesthetics were included in this study. The data collected included patients' demographic information, initial best corrected visual acuity (BCVA), clinical findings, time to AMT, duration of epithelization, additional treatments, posttreatment BCVA, and the results of psychiatric examination. All patients were male, with the mean age of 37.9±5.4y. The patients had received 0.5% proparacaine hydrochloride due to pain resulting from foreign bodies, such as welding flash burns and car battery explosions, for a mean of 18.2±12.4d. The mean initial BCVA of the patients was 0.069±0.100. All patients had persistent epithelial defects, stromal infiltration, ring ulcer, and corneal edema. Initially, medical treatment was attempted in all cases. Because of severe pain, persistent epithelial defects and progressing stromal thinning did not improve with medical treatment, thus, the patients underwent AMT. The mean posttreatment BCVA of the patients was 0.33±0.27. All of them, except for two patients, showed improved visual acuity. One patient underwent evisceration for corneal melting and endophthalmitis in another center, and one patient underwent evisceration for severe pain of unknown origin. All 5 patients who consented to a psychiatric examination had depression, had personality disorder, and used tobacco. AMT appears to be an effective method for pain relief, rapid epithelial and stromal healing; however, visual prognosis is still poor despite medical and surgical interventions.

Surgical Resection and Amniotic Membrane Transplantation for Treatment of Refractory Giant Papillae in Vernal Keratoconjunctivitis

The aim of this study was to evaluate the outcome of surgical resection and amniotic membrane transplantation (AMT) for treatment of refractory symptomatic giant papillae in vernal keratoconjunctivitis (VKC). This is a retrospective study of 13 eyes of 9 patients with refractory giant papillae associated with corneal shield ulcer and/or punctate epithelial erosions who underwent surgical resection of the papillae combined with AMT to cover the tarsal conjunctival defect. During 14.2 ± 4.2 months of postoperative follow-up, smooth tarsal conjunctival surface was achieved in all cases, with no recurrence of the giant papillae in any eye. Corneal shield ulcers and punctate epithelial erosions healed within 2 weeks after surgery and did not recur during the follow-up. Best-corrected visual acuity improved from 0.26 ± 0.21 logarithm of the minimum angle of resolution preoperatively to 0.02 ± 0.04 logarithm of the minimum angle of resolution postoperatively (P = 0.01). Three patients experienced recurrence of VKC symptoms, but without giant papillae, which could be well controlled by topical medications. Surgical resection combined with AMT is an effective procedure for treatment of refractory giant papillae in patients with VKC.

Amniotic Membrane Transplantation in Treatment of Persistent Corneal Ulceration after Severe Chemical and Thermal Eye Injuries

To analyze results of amniotic membrane transplantation (AMT) in treatment of corneal ulceration after severe chemical and thermal injuries. Analysis of 55 AMT in 53 patients (53 eyes) with corneal ulceration and limbal deficiency 180-360° of the limbus after grade 4-6 (Dua classification, 2001) chemical and thermal injuries was performed. Mean terms of the operation were 46.1 ± 46.4 days after the injury (range 8-181 days). Preoperative visual acuity (VA) was <0.01 in 33/53 patients (62.3%). Mean follow-up period was 8.8 ± 10.1 months (range 1.5-46 months). Further corneal ulceration was prevented in 54/55 cases (98.1%), cornea epithelialized after 42/55 AMT (76.3%). Mean terms of corneal epithelialization were 24.2 ± 26.7 days after AMT (range 6-123 days). Corneal defect recurred in 3/42 successful cases (7.1%). Limbal deficiency of different extent with subsequent corneal conjunctivalization developed in all successful patients. The VA was ≥0.01 (range 0.01-1.0) in 23/42 patients (54.8%) with corneal epithelialization. The VA at the last visit was improved on 2 and more lines on the eye chart compared to preoperative VA in 15/42 patients with corneal epithelialization (35.7%), did not change in 18/42 successful patients (42.9%), and decreased on one line in 9/42 of these patients (26.2%). Symblepharon developed in 23/42 successful patients (54.7%). Amniotic membrane transplantation may stop ulceration and promote corneal epithelialization in the majority of patients with the most severe chemical or thermal eye injuries in case of timely application of the operation and adequate fixation of the AMT graft.

Analysis of results of amniotic membrane transplantation in treatment of persistent corneal ulceration after severe eye burns

Analysis of results of amniotic membrane transplantation in treatment of persistent corneal ulceration after severe eye burns

Five-Layered Reinforcing Amniotic Membrane Transplantation for Treatment of Deep Corneal Ulcer or Perforation

Five-Layered Reinforcing Amniotic Membrane Transplantation for Treatment of Deep Corneal Ulcer or Perforation

Microtechnique of bilayer amniotic membrane transplantation for treatment of Mooren's ulcer

Objective To investigate the mierotechnique of bilayer amniotic membrane transplantation for treatment of Mooren's ulcer and evaluate the efficacy. Methods Six patients (6 eyes) with Mooren's ulcer were recruited for this study. After medical treatment or lameilar keratoplasty failed to arrest progress of corneal ulcer, bilayer amniotic membrane transplantation was performed for the treatment. We investigated the integrity of corneal epithelium, the healing of corneal ulcer, the improvement of stromal edema, the atrophy of neovessels, the transformation of amniotic membrane and the occurrence of relapse. Results All patients were followed up for 24-34 months (mean 30 months). In all cases, superficial anmiotic membrane dissolved or shed on postoperative day 7-11, disconnecting now. Corneal ulcer healed within 7-15 days postoperatively. In 5 eyes, corneal stromal edema faded away within 2-3 weeks. Corneal neovessels regressed within 2-3 months. The deeper grafts were adhered into the ulcer and fused with the cornea 3 months after the operation. Corneal transparence or macula was achieved within 5-8 months. No recurrence of Moorcn's ulcer was oc-curred in 4 patients during the follow-up period, while 2 eyes relapsed for the exposure of sutures and not re-moving the stitches timely, which had been treated with lamellar keratoplasty and no recurrence again during the follow-up period. Conclusion Bilayer amniotic membrane transplantation has advantages for Mooren's ulcer treatment. Mastering the microsurgical techniques and removing the stitches timely are the key to the success of surgery. It also provides good conditions for the further conduct of keratoplasty. Key words: Amnion; Mooren's ulcer; Transplantation; Microsurgical operation

Transplante de membrana amniótica em casos agudos graves de queimadura ocular química e síndrome de Stevens-Johnson

To study the therapeutic potential of amniotic membrane transplantation in cases of severe acute chemical ocular burn and Stevens-Johnson syndrome. We retrospectively reviewed the records of eight patients, with a total of ten eyes, submitted to amniotic membrane transplantation for treatment of ocular chemical burns and Stevens-Johnson syndrome in the acute phase between January 1999 and May 2008 in the Ophthalmology Department of UNIFESP. Data relating to sex, age, degree of chemical burns, etiology, affected eye, ophthalmological findings, extension of amniotic membrane, surgeries, additional time between the injury and surgery in days, visual acuity before and after surgery, epithelial defect healing (days), complications and time of follow-up in months were collected. The average age of patients was 35.7 +/- 23.04 years, with six men and two women. Three patients (four eyes) had Stevens-Johnson syndrome and five patients (six eyes) had chemical ocular burn. The epithelial defect was healed at an average of 27.8 +/- 4.7 days (ranging from 20 and 35 days). All patients presented limbal stem cell deficiency in a median follow-up of 7.8 +/- 2.8 months (ranging from six and twelve months) and four eyes developed symblepharon. The results suggest that the amniotic membrane transplantation represents an additive that can be carried out in the serious cases of ocular chemical burn and Stevens-Johnson syndrome with the finality of promoting the epithelialization and abolishing the inflammation and its consequences, if compared with other studies that treated similar cases with medical therapy only. On the other hand, it is not possible to avoid the limbic deficiency in these cases, which in the future will need limbal stem cell transplantation or other surgeries for correction of the ocular surface.

Amniotic Membrane Transplantation for Treatment of Symblepharon in a Patient With Recessive Dystrophic Epidermolysis Bullosa

To report the surgical treatment of a case with epidermolysis bullosa. A 12-year-old girl with dystrophic epidermolysis bullosa presented to our clinic with a symblepharon connecting the lateral half of the left upper lid to the upper temporal quadrant of the cornea. The central cornea exhibited diffuse opacity and vascularization. During surgery, the symblepharon was lysed, and lamellar keratectomy was performed. The operated portion of cornea and palpebral conjunctiva was covered with amniotic membrane to promote healing. Fourteen months later, the operated eyelid margin was normal and the eye was fully mobile. The temporal portion of the corneal stroma was still thinner than normal and showed mild superficial vascularization and opacification. We believe that amniotic membrane transplantation is a valuable way to treat symblepharon in cases of epidermolysis bullosa.

Fresh amniotic membrane transplantation for recurrent pterygium

目的 观察新鲜羊膜移植治疗复发性翼状胬肉的疗效.方法对27例(32只眼)复发性翼状胬肉患者作翼状胬肉切除联合新鲜羊膜移植,术后随访6个月至3年.结果随访期间除2只眼(6.25%)复发外,其余全部治愈.结论翼状胬肉切除联合新鲜羊膜移植是治疗复发性翼状胬肉的有效方法。

Fresh lamellar keratoplasty associated with amniotic membrane transplantation for treatment of recurrent pterygium

目的 探讨新鲜板层角膜联合羊膜移植治疗复发性翼状胬肉的临床效果.方法复发性翼状胬肉16例(22眼),采用新鲜板层角膜联合羊膜移植进行治疗,并随访观察6月～2年.结果全部患者上皮愈合良好稳定,表面完整光滑,角膜基本透明,视力保持不变,无排斥反应,无复发.结论新鲜板层角膜含健康的角膜缘干细胞和角膜上皮细胞,可迅速修复损伤的角膜表面.羊膜有抗炎、抑制血管新生及纤维化,阻止变性结膜组织生长的作用,用新鲜板层角膜联合羊膜移植治疗复发性翼状胬肉效果显著。

Clinical effect of autograft limbal stem cell transplantation or amniotic membrane transplantation for treatment of pterygium

目的 观察自体角膜缘干细胞移植或羊膜移植治疗翼状胬肉的临床效果.方法43例(43眼)翼状胬肉随机分为2组:羊膜移植组(23例)、角膜缘干细胞移植组(20例).术后对其角膜创面愈合、羊膜及角膜缘干细胞植片生长状况,以及有无角膜创面新生血管和胬肉组织侵入等情况进行观察.结果术后3月,羊膜移植组有2例复发(8.70%),角膜缘干细胞移植组未见复发.结论羊膜移植及角膜缘干细胞移植治疗翼状胬肉均可显著降低胬肉的复发率。

A clinical observation of amniotic membrane transplantation for treatment of ocular surface disorders

目的 探讨羊膜移植治疗眼表疾病的临床效果.方法采用新鲜羊膜移植治疗几种眼表疾病25例(27眼),术后随访观察3月～1年.结果复发性翼状胬肉2眼3月后复发;1眼360°蚕蚀性角膜溃疡伴穿孔,行多层羊膜移植,1月后,部分羊膜脱落,再次给予羊膜加巩膜、结膜覆盖后治愈.结论羊膜移植重建眼表是目前较理想的治疗手段。