Efficacy Of Amniotic Membrane Transplantation Research Articles

Amniotic Membrane Transplantation for Paracentral Corneal Perforations

Objective: To report the clinical efficacy of Amniotic Membrane Transplantation (AMT) for paracentral perforations caused by Blepharokeratoconjunctivitis (BKC). Methods: A retrospective review was performed on consecutive patients that had paracentral corneal perforations caused by BKC and were subsequently treated with AMT between October 2019 and September 2021. Visual acuity (BCVA), anterior chamber depth, angle opening, corneal thickness and number of Demodex mites were examined before and after the operation. Results: Eleven eyes of 11 patients (2 males, 9 females, aged 11- 22 years old) with BKC were included in the analysis. Three months after AMT, BCVA significantly improved from 1.14 ± 0.8 at baseline to 0.35 ± 0.2 (p=0.004) and the proportion of patients with mite infestation decreased from 7 cases (64%) to 2 cases (18%). OCT confirmed the corneal perforations healed with normal corneal thickness and formation of anterior chamber with normal angle opening. During the follow up duration of 6-17 months, no recurrence or complications were noted. Conclusion: This case series suggests AMT can restore vision and corneal thickness in patients with aseptic corneal perforations caused by BKC.

Visual Acuity and Number of Amniotic Membrane Layers as Indicators of Efficacy in Amniotic Membrane Transplantation for Corneal Ulcers: A Multicenter Study.

Background: To evaluate new indicators in the efficacy of amniotic membrane transplantation (AMT) for non-healing corneal ulcers (NHCUs). Methods: Retrospective, multicenter study. In total, 223 AMTs for NHCU in 191 patients were assessed. The main outcomes studied were the success rate of AMT (complete re-epithelization), postoperative visual acuity (VA) gain, and number of AM layers transplanted. Results: The overall AMT success rate was 74.4%. In 92% of our patients VA stability or improvement. Postoperative VA was significantly higher than preoperative VA in the entire cohort (p < 0.001) and in all etiological groups of ulcers (post-bacterial, p ≤ 0.001; post-herpetic, p ≤ 0.0038; neurotrophic ulcers, p ≤ 0.014; non-rheumatic peripheral, p ≤ 0.001; and ulcers secondary to lagophthalmos and eyelid malposition or trauma, p ≤ 0.004). Most participants (56.5%) presented a preoperative VA equal to or less than counting fingers (≤0.01). Of these, 13.5% reached a postoperative VA equal to or better than legal blindness (≥0.05) after AMT. A higher success rate was observed in the monolayer than in the multilayer AMT (79.5% and 64.9%, respectively; p = 0.018). No statistically significant values were found between the number of layers transplanted and VA gain (p = 0.509). Conclusion: AMT is not only beneficial in achieving complete re-epithelialization in NHCUs but also in improving postoperative VA; these improvements are independent of etiologies of ulcers. Furthermore, the use of monolayer AMT seems to be a more appropriate option than multilayer AMT for NHCU since the multilayer AMT did not present better outcomes (success rate and VA gain) compared to monolayer AMT in the different types of ulcers studied.

Efficacy of Amniotic Membrane Transplantation for the Treatment of Corneal Ulcers.

To evaluate the outcome of amniotic membrane transplantation (AMTX) as a treatment for corneal ulcers. Patients treated with AMTX for refractory corneal ulcers between 2012 and 2017 were evaluated in a retrospective analysis. Primary outcome measure was complete reepithelialization. A total of 149 patients were included (mean age 68 ± 18 years). The mean duration between ulcer onset and AMTX was 42 ± 46 days. The longest time between ulcer diagnosis and AMTX was found in bacterial ulcers and the shortest time to AMTX in eyes with trauma/chemical burns (mean 65 ± 15 days and 14 ± 4 days, respectively). In 70% of the patients, a single AMTX procedure was sufficient to achieve epithelial closure (21% <1 month, 40% within 1 -3 months, and 9% within 3-6 months). Treatment failure was observed in 30% of all patients, and most of them underwent further interventions. Highest closure rates were found in bacterial ulcers, herpetic ulcers, and neurotrophic ulcers (80%, 85%, and 93%, respectively), whereas the lowest reepithelialization rates were found in ulcers after corneal surgery and ulcers associated with rheumatic disease (52% and 57%, respectively). AMTX is a valuable treatment option to achieve corneal epithelial wound healing in cases refractory to conventional treatment. Success rates differ depending on the etiology of ulcer.

Comparison of the Efficacy of Amniotic Membrane Transplantation, Topical Water-Based Propolis Extract, Corticosteroid and Antibiotic Use in Different Combinations on Subacute Corneal Alkali Burns in Rabbits

Comparison of the Efficacy of Amniotic Membrane Transplantation, Topical Water-Based Propolis Extract, Corticosteroid and Antibiotic Use in Different Combinations on Subacute Corneal Alkali Burns in Rabbits

Efficacy of amniotic membrane transplantaion combined with limbal stem cell autograft transplantation for recurrent pterygium with symblepharon

Objective To evaluate the efficacy of amniotic membrane transplantation combined with limbal stem cell autograft transplantation for recurrent pterygium with symblepharon. Methods The data of 12 eyes of 12 cases with recurrent pterygium and symblepharon from Apr. 2013 to Aug. 2016 were collected and analyzed retrospectively. They underwent amniotic membrane transplantation combined with limbal stem cell autograft transplantation, and the application of mitomycin C during surgery. Results The follow-up period was 8-36 months, pterygium recurred in 1 case after surgery and the recurrent rate was 8.33%. No symblepharon or histolysis complication occurred. Conclusion Amniotic membrane transplantation combined with limbal stem cell autograft transplantation and application of mitomycin C intraoperatively for recurrent pterygium with symblepharon is efficient. Key words: Pterygium, recurrent; Symblepharon; Transplantaion, amniotic membrane; Transplantation, limbal stem cell autograft; Mitomycin C

Efficacy of Amniotic Membrane Transplantation in Refractory Infective Keratitis Leading to Stromal Thinning, Descematocele and Perforations

Efficacy of Amniotic Membrane Transplantation in Refractory Infective Keratitis Leading to Stromal Thinning, Descematocele and Perforations

Fornix reconstruction with amniotic membrane transplantation: A cosmetic remedy for blind patients

Purpose:Fornix contracture is an obstacle for fitting a prosthesis in blind or enucleated patients, and may lead to disfigurement and psychological issues. This study evaluates the efficacy of amniotic membrane transplantation (AMT) for fornix reconstruction with the aim of better retention of the ocular prosthesis.Methods:This non-comparative interventional case series includes eighteen blind eyes with fornix deformity in which a cosmetic prosthesis could not be retained. Various causative factors included symblepharon, cyst formation and fornix shortening after enucleation. AMT was performed along with correction of symblepharon, cicatrix release, and excision of the cyst with or without anchoring sutures to reform the fornix.Results:Mean fornix depth pre- and post-operation were 3.72 ± 0.69 and 7.13 ± 0.81 mm, respectively. Fornix deepening was achieved successfully in 15 cases (83.33%). Partial success was achieved in 1 case (5.66%); the remaining two cases (11.11%) were considered as failure despite repeat surgery. Both of these patients suffered from extensive symblepharon formation. Satisfactory results, i.e. formation of a deep fornix to hold the ocular prosthesis, could be achieved in 16 (89.99%) cases. There were no serious complications such as infection or graft rejection.Conclusion:AMT can be a viable option for fornix reconstruction. It has a high success rate in subjects with blind eyes and moderate fornix shortening who are unable to retain an ocular prosthesis.

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.

Amniotic membrane transplantation in surgical management of ocular surface squamous neoplasias: long-term results.

To evaluate the long-term efficacy of amniotic membrane transplantation for ocular surface reconstruction in the surgical management of ocular surface squamous neoplasia (OSSN). OSSN in 21 patients (7 female, 14 male patients) was managed with excisional biopsy, cryotherapy, corneal epitheliectomy with absolute alcohol application when the cornea is involved, lamellar sclerectomy and adjunctional absolute alcohol application to the base when episclera is involved, and ocular surface reconstruction with cryopreserved amniotic membrane transplantation. Tumor control and complications were evaluated. The mean age of the patients was 62.42 ± 20.9 (range, 16-84). The average diameter of the base of the tumors was 13.1 ± 4.8 (range, 9-21) mm and complete removal was achieved in all cases as revealed histopathologically. Ocular surface healing was achieved in all cases. At the postoperative period, limbal stem cell deficiency in three eyes and mild symblepharon in one eye were detected. In a mean follow-up of 30.95 ± 18.8 (range, 13-75) months, no recurrence was detected. For large or multifocal conjunctival tumors, the reconstruction of ocular surface and fornix is challenging. The amniotic-membrane use to repair conjunctival defects larger than 10 mm is a safe and effective technique with minimal complications allowing surgeons to make large enough excisions.

Long-Term Results of Amniotic Membrane Transplantation for Partial Limbal Deficiency

To evaluate the long-term efficacy of amniotic membrane transplantation as a treatment option in cases with partial limbal deficiency. Sixteen eyes of 14 patients with partial limbal deficiency underwent amniotic membrane patch (AMP) or amniotic membrane graft with patch (AMGP) following keratectomy for conjunctivalization of the cornea. The average follow-up period was 52 months. We evaluated the mean corneal epithelialization time, visual acuity improvement, complications, and recurrence rate after the surgery. Eleven eyes underwent AMP, and the remaining 5 eyes received AMGP. All eyes eventually attained corneal reepithelialization. The mean time to reepithelialization was not significantly different between the AMP group (9 days) and the AMGP group (27 days). At the final follow-up visit, improved Landolt visual acuity was observed in 6 of the 11 eyes in the AMP group and in 2 of the 5 eyes in the AMGP group. No intraoperative complications were observed. However, 6 eyes in the AMP group and 3 eyes in the AMGP group had a recurrence or developed a persistent epithelial defect after mean durations of 21.2 and 17.7 months, respectively. Both AMP and AMGP appear to be effective in attaining corneal reepithelialization, but neither could provide stable, clear corneal epithelialization in the long term.

Efficacy of amniotic membrane transplantation (AMT) on corneal surface in bullous keratopathy eyes

AbstractPurpose To determine the effect of cryopreserved amniotic membrane transplantation (AMT) on a patients with bullous keratopathy in pseudophakia eyes.Methods This retrospective study included 5 eyes (5 patients) with bullous keratopathy in pseudophakia eyes presenting with intractable pain or discomfort (photophobia, tearing and foreign‐body sensation). A transplantation of sutureless temporary cryopreserved amniotic membrane was performed on all eyes suffering from bullous keratopathy. The average duration of the follow‐up was 14.1 months +/‐ 1.6 (SD) (range 12 to 16 months).Results After the AMT was established a significant improvement. We observed complete corneal epithelial healing in all eyes. Sixty percent of the 5 eyes had improvement of the ocular discomfort soon after the first postoperative day. Pain relief was obtained in 80% of patients.Conclusion The AMT was efficient, safe, and successful method of treatment for intractable pain with chronic bullous keratopathy. Future studies comparing AMT to other methods of treatment of bullous keratopathy would help to better define the role of AMT in ocular surface disease and perhaps further elucidate the mechanisms by which this therapy works. Keywords: Amniotic membrane transplantation, pseudophakia, bullous keratopathy, intractable pain, discomfort

A controlled study of amniotic membrane transplantation for acute Pseudomonas keratitis

ObjectiveTo evaluate the efficacy of amniotic membrane transplantation (AMT) to improve the outcomes of acute Pseudomonas keratitis as compared with a control group. DesignProspective interventional case series with retrospective controls. ParticipantsWe studied 14 eyes with Pseudomonas keratitis as the AMT group and 11 eyes with Pseudomonas keratitis as the control group. MethodsEyes in the AMT group were treated with antibiotic therapy followed by single-layer AMT at 2 to 3 days. Eyes in the control group received only antibiotic therapy. Patients were followed for 11.1 ± 2.4 months. ResultsIn the AMT group, pain significantly decreased from a mean score of 2.4 ± 0.5 preoperatively to 1.1 ± 0.9 at day 2 postoperatively (p < 0.001). Corneal epithelial defects healed completely within 13.2 ± 2.6 days in the AMT group compared with 15.5 ± 3.4 days in the control group (p = 0.07). At final follow-up visits, the sizes of corneal opacity and deep neovascularization were not different between the 2 groups. However, the mean score for density of the corneal opacity was significantly less in the AMT group compared with the control group (2.1 ± 0.4 vs 2.5 ± 0.7, respectively, p = 0.04). Although the best corrected visual acuity using hard contact lenses was not different between the 2 groups, uncorrected visual acuity was better in the AMT group (0.45 ± 0.22 logMAR) than in the control group (0.71 ± 0.32 logMAR, p = 0.03). No patient in either group developed significant corneal thinning or perforation. ConclusionsAMT in acute Pseudomonas keratitis was associated with immediate pain relief, less density of the final corneal opacity, and better uncorrected visual acuity at the final follow-up visit.

Comparison of clinical efficacy of three surgical methods in the treatment of pterygium.

To investigate and compare the efficacy of amniotic membrane transplantation, corneal limbus stem cell conjunctival transplantation and pedicle conjunctival flap transposition in the treatment of pterygium. A total of 155 patients with pterygium were retrospectively analysed: 53 cases who received amniotic membrane transplantation, 41 who underwent corneal limbus stem cells conjunctival transplantation, and 63 patients who had pedicle conjunctival flap transposition. Patients in the three groups had no significant differences in terms of age, times since surgery, or extent of pterygium extension onto the cornea (F:1.194, 0.639, 0.140 respectively; all P>0.05). A total of 137 out of 155 patients (88.4%) completed 6 months of follow up. The recurrence rates of pterygium for the three surgeries (amniotic membrane transplantation, corneal limbus stem cells conjunctival transplantation and pedicle conjunctival flap transposition) were 14.6%, 13.9% and 7.7%, respectively. No significant difference was identified when comparing the recurrence rate between any two groups (X2: 0.008, 1.211 and 0.890; P: 0.593, 0.218 and 0.276). Five patients presented with postoperative complications, including 3 cases of sub-conjunctival hemorrhage, 1 case of amniotic membrane dissolution, and 1 case of conjunctival cyst, accounting for 3.64% of all participants. These three surgical methods are equally effective in preventing the recurrence of pterygium after excision.

Amniotic membrane transplantation in corneal melting after anterior lamellar keratoplasty assisted by femtosecond laser in children

To evaluate the efficacy of amniotic membrane transplantation in lamella melting after anterior lamellar keratoplasty (ALK) assisted by femtosecond laser in a pediatric patient. An 11-year-old girl with progressive keratoconus underwent ALK assisted by femtosecond laser on the right eye. The surgical procedure was performed under general anesthesia. The 60-KHz IntraLase femtosecond laser (Abbott Medical Optics) created both the donor (thickness 350 µm; diameter 8.1 mm; side cut 70°) and recipient (thickness 260 µm; diameter 8.0 mm; side cut 70°) lamellae. The recipient lamella was then gently removed and donor was fitted into place and sutured using 4 interrupted sutures added to a running suture in nylon 10-0. The surgery was uneventful. Two months after surgery, a lamella melting was observed. One month after topical steroid treatment, amniotic membrane transplantation was performed. When lamella melting was observed, the best-corrected visual acuity (BCVA) was 0.1 and 0.5 with foramen and no inflammatory reaction in the anterior chamber was reported. Eleven months after amniotic membrane transplantation, BCVA was 0.9 and no visual acuity increase was recorded with foramen. Our findings show that amniotic membrane transplantation could be considered in lamella melting after ALK assisted by femtosecond laser in children.

Prognosis of Paraquat-Induced Ocular Surface Injury: Therapeutic Effect of Amniotic Membrane Transplantation

To investigate the prognosis of paraquat-induced ocular surface injury and the therapeutic efficacy of amniotic membrane transplantation for the treatment of ocular surface damage. Twenty patients (26 eyes) with ocular surface injury caused by paraquat were studied. Twelve patients (14 eyes) underwent amniotic membrane transplantation combined with medical treatment (group A), and 8 patients (12 eyes) received medical treatment only (group B). Visual acuity, time to epithelial defect closure, stromal haze, and complications were analyzed. The grade of the ocular surface injury was mild in 19 eyes (73.1%). Visual acuity improved in 20 eyes (76.9%). The epithelial defect healed completely in 25 eyes (96.2%), with a mean healing time of 16.04 +/- 6.22 days. At the final visit, 80.8% of cases had no stromal haze. The mean time to epithelial defect closure was 13.43 +/- 3.55 days in group A and 19.18 +/- 7.25 days in group B (P = 0.03). Complications included punctal stenosis (2 eyes) and pannus (1 eye) in group A and conjunctivalization (1 eye) and symblepharon (1 eye) in group B. Paraquat-induced ocular surface injury had a relatively good prognosis. Amniotic membrane transplantation was helpful in shortening the time to closure of the epithelial defect.

Efficacy of Amniotic Membrane Transplantation on Corneal Graft Rejection with Epithelial Defects after Penetrating Keratoplasty

We report the therapeutic effect of amniotic membrane transplantation (AMT) on corneal graft rejection with epithelial defects after penetrating keratoplasty (PKP). Twelve patients (12 eyes) who had epithelial and subepithelial graft rejection received human AMT, and they were compared with other 12 patients (12 eyes) who were treated with medication only. There were no differences in age, sex, time to rejection after PKP, and epithelial defect area between two groups. Time to epithelial healing and time to disappearance of rejection sign were significantly shorter in the AMT group (11.8±4.9 days and 15.5±6.3 days) than in the medical treatment group (19.0±3.7 days and 20.8±3.4 days)(p=0.01, p=0.02). AMT is effective in promoting epithelialization and improving inflammation of epithelial rejection after penetrating keratoplasty.

Clinical efficacy of amniotic membrane transplantation in the treatment of various ocular surface diseases

Purpose To investigate the efficacy of permanent amniotic membrane transplantation (AMT) for the treatment of various ocular surface diseases. Methods The medical records of 62 eyes from 58 patients who had undergone permanent AMT were reviewed. The amniotic patches were grafted for the treatment of neurotrophic ulcers ( n = 15), inflammatory corneal ulcers ( n = 15), scleral ulcers ( n = 11), painful bullous keratopathy ( n = 8) and pterygium as an adjuvant to a conjunctival autograft ( n = 13). Cryo-preserved or freeze-dried amniotic membrane (AM) were used. The overall success rate, the interval to epithelialization, pain-subsiding time, and complications were evaluated. The pain relief and the full epithelialization interval in the bullous keratopathy patients given the cryo-preserved AM were compared with those given the freeze-dried AM. Results The success rate in the patients with neurotrophic ulcer, inflammatory corneal ulcer, scleral ulcer and bullous keratopathy were 93.3%, 66.7%, 92.9% and 100%, respectively. A conjunctival autograft with AMT showed a 100% success rate without recurrence. The time to re-epithelialization was 24.4 ± 24.2, 20.4 ± 5.8, and 16.9 ± 7.0 days in patients with neurotrophic, inflammatory and scleral ulcers, respectively ( p = 0.431). The pain relief interval in the cryo-preserved and freeze-dried AM group was 17.7 and 23.3 days, and the re-epithelialization interval was 29 and 22 days, respectively, which was insignificant. Conclusions AMT has a high success in the treatment of neurotrophic, scleral ulcer, bullous keratopathy and pterygium with a low rate of complications but presented only partial success in the treatment of inflammatory corneal ulcers. The clinical efficacy of AMT was not related to the methods used to preserve the AM.

Amniotic membrane transplantation or combined with limbal autograft transplantation for the treatment of pterygium

目的 观察单纯羊膜移植与联合自体角膜缘移植治疗翼状胬肉的疗效.方法 将翼状胬肉85例(93眼)随机分成两组,A组44例(45眼)行羊膜移植术,B组41例(48眼)行自体角膜缘移植联合羊膜移植术.术后平均随访2年,比较两组的治愈情况及复发率.结果 A组有4眼复发,其中有3眼是复发性翼状胬肉,复发率8.89%(4/45).B组仅1眼复发,复发率为2.08%(1/48).两组复发率差异有统计学意义(P＜0.05).结论 自体角膜缘移植联合羊膜移植术有利于翼状胬肉术后的眼表重建,临床疗效优于单纯羊膜移植术。

Rate of epithelialisation and re-operations in corneal ulcers treated with amniotic membrane transplantation combined with botulinum toxin-induced ptosis

To examine the efficacy of amniotic membrane transplantation (AMT) and/or botulinum toxin type A-induced ptosis (Dysport) in the treatment of corneal ulcerations of different entities. Retrospective evaluation of 137 cases of corneal ulcers which have been treated with AMT, botulinum toxin type A and perforating keratoplasty (pKP). Regarding corneal ulcerations the patients were divided into three groups: group A, patients initially having received an AMT (92 eyes eventually followed by AMT or pKP as a second intervention); group B, patients initially having received an AMT (32 eyes followed by botulinum toxin type A injection in the upper lid as a second intervention); group C, patients initially treated only by botulinum toxin type A injection (13 eyes followed occasionally by AMT or pKP or additional botulinum toxin type A injection). Additionally, we analysed the complete epithelialisation rate of the ocular surface in respect to different ocular and systemic diseases and compared the frequency of re-operations in each group. The overall follow-up was 14.2 (+/-14.7 months; range from 1 to 60 months). The total frequency of re-operations was 45.3% (overall time until complete epithelialisation 12.7 (+/-6.1) days). If the patient was initially treated with an AMT (group A), the re-operation rate was 44.6%. Treating affected eyes in this group with a subsequent amniotic membrane resulted in a reduction of re-operation rate to 30.4%. In cases with induced ptosis by injecting botulinum toxin type A in the M. levator palpebrae (group B), the re-operation frequency could be reduced to 34.4% with similar times of epithelialisation [group A: 12.0 (+/-6.5) days and group B: 11.7 (+/-5.5) days]. In group C, with botulinum toxin type A alone initially, the re-operation rate of 69.2% was the highest one compared with groups A and B; this rate could be drastically reduced by a following AMT to 23.1%. Surprisingly, in the few successful cases with botulinum toxin type A alone a quite low epithelialisation time of 6.5 (+/-1.3) days was achieved, but turned out to be similar after additional interventions if compared with the other groups (botulinum toxin type A + AMT: 15.7 (+/-4.9) day). AMT alone and combined with botulinum toxin type A-induced ptosis is an effective surgical approach for managing severe corneal ulcerations by promoting wound healing and stabilizing ocular surface homeostasis.

Amniotic membrane transplantation in refractory corneal ulcers. A randomized, controlled clinical trial

This study compared the efficacy of amniotic membrane transplantation with conventional management (tarsorrhaphy and bandage contact lens) in eyes with refractory neurotrophic corneal ulcers. Thirty eyes of 30 patients (14 males and 16 males; mean age = 37 ± 14.71 years) with neurotrophic corneal ulcers that had persisted for at least 4 weeks and were sterile on microbiologic examination were included and randomly divided into group 1 (n = 15), who received conventional management with a tarsorrhaphy (n = 11) or bandage contact lens (n = 4), and group 2 (n = 15) who underwent amniotic membrane transplantation (AMT). At the end of 3 months of follow-up, 10 (66.7%) eyes in group 1 and 11 (73.3%) eyes in group 2 showed complete re-epithelialization (P > .05). The median time for re-epithelialization in both groups was 21 days. Both groups showed similar improvement in best-corrected visual acuity. The conclusion was that both conventional therapy and amniotic membrane transplantation are effective treatment modalities for refractory neurotrophic corneal ulcers.—Michael D. Wagoner