Multilayer Amniotic Membrane Research Articles

Single and multilayer amniotic membrane transplantation for persistent corneal epithelial defect with and without stromal thinning and perforation

AIMSTo evaluate the efficacy of amniotic membrane transplantation (AMT) in persistent corneal epithelial defect with or without stromal thinning and corneal perforation.METHODS28 patients (28 eyes) with persistent corneal epithelial defect...

Multi-layer Amniotic Membrane Graft for Pterygium in a Patient with Xeroderma Pigmentosum

Background: Xeroderma pigmentosum (XP) is a rare, autosomal recessive, premalignant condition of the skin, and is reported to be associated with ocular surface disorders such as conjunctival malignancy and pterygium. Herein, we report a case of successful management of pterygium with multi-layer amniotic membrane graft (AMG) in a young XP patient. Case: An 11-year-old Japanese girl, who had been diagnosed as having XP, was referred to us for treatment of her bilateral pterygium. Surgical intervention was attempted for a temporal, presumably fast-growing pterygium in her left eye. Multi-layer amniotic membrane grafting was performed. Observations: The surgery-induced pain and irritation disappeared within a day. The limbal conjunctival autograft survived on the AMG and re-epithelialization over the AMG was completed in 2 weeks. Best corrected visual acuity improved from 20/32 to 20/16 one month postoperatively. During the 1-year follow-up period, no recurrence was noted. Conclusions: The present case exemplifies that AMG as an adjunct to primary pterygium resection is effective even in a young patient with XP. In addition, multi-layer AMG, which we first demonstrated in this report, seems to be useful for protecting bare sclera and extraocular muscles from mechanical injury.

Multilayer amniotic membrane transplantation for corneal ulcers not treatable by conventional therapy - a prospective study of the status of cornea and graft during follow-up

The purpose of this prospective clinical study was to evaluate the condition of the cornea (epithelium and vascularization) and the membrane presence and retraction during follow-up after amniotic membrane transplantation in patients with persistent corneal ulcers. Between June 1999 and November 2000 AM transplantation was performed in 30 consecutive patients (average age 59 +/- 17 years) with corneal ulcers refractory to clinical treatment. We evaluated the clinical diagnosis, localisation, size and depth of the ulcers, condition of the ocular surface and visual acuity before and after surgery. After complete removal of the epithelium and pannus, one (n=11), two (n=17) or three (n=2) layers of amniotic membrane were fixed with multiple interrupted sutures, depending on the depth of the lesion. A therapeutic contact lens was applied in most eyes and removed after one month. The most frequent diagnoses were chemical burn (5 x lime, 1 x lye and 1 x liquid aluminium), 7 x herpes, 3 x polyarthritis and 3 x blepharo-keratoconjunctivitis in neurodermitis. The ulcers had a medium length of 4.9 +/- 3.2 mm, a width of 3.5 +/- 3.0 mm and a depth ranging between 30 % and 95 % (68 +/- 21 %). Complete epithelial closure was achieved in 27 of 30 eyes (90 %). In 4 eyes a recurrent epithelial defect occurred after initial closure. At the 1-, 3- and 6 month follow-up the amniotic membrane was present in 93 %, 73 % or 30 %, respectively, but was more or less retractet in 52 %, 58 % or 67 %, respectively. A complete corneal epithelium was noted in 79 %, 89 % or 90 % of eyes, respectively. However, corneal neovascularization was observed in 24 %, 58 % or 60 % of eyes. Visual acuity was </= 20/400 in 60 % eyes preoperatively, but in 69 % after 3 months and in 78 % after 6 months of follow-up. In persistent corneal ulcers, amniotic membrane transplantation should be considered in early stages to achieve permanent epithelial closure in a less inflamed eye thus avoiding penetrating keratoplasty à chaud or conjunctival flaps. However, in eyes with broad descemetocele especially following chemical burns, this treatment modality does not seem to be effective.

Multilayered amniotic membrane transplantation for severe ulceration of the cornea and sclera

PURPOSE: To examine the efficacy of amniotic membrane transplantation in the treatment of deep corneal and scleral ulcers. PATIENTS: A total of 11 patients were recruited for this study: four patients (four eyes) with corneal perforation, five patients (five eyes) with a deep corneal ulcer and descemetocele, and two patients (two eyes) with a scleral ulcer. METHODS: Ulcers were treated by amniotic membrane transplantation. Separate amniotic membranes were transplanted as material to fill the stromal layer (amniotic membrane filling), as a basement membrane (amniotic membrane graft), and as a wound cover (amniotic membrane patch). After surgery, all cases were treated with artificial tears, autologous serum drops, antibiotic eyedrops, topical corticosteroids, and sodium hyaluronate eyedrops. RESULTS: Eight eyes (72.7%) healed with epithelialization in 16.5 ± 8.0 days (range, 7 to 29 days), with five and three eyes showing corneal epithelialization and conjunctival epithelialization, respectively. A persistent epithelial defect was noted in one eye with corneal ulcer after limbal allograft transplantation for a chemical burn and in two eyes with corneal ulcers as a complication of rheumatoid arthritis. CONCLUSION: Multilayered amniotic membrane transplantation may be effective for the treatment of deep ulceration of the cornea and sclera. In some eyes with total corneal limbal dysfunction or autoimmune disorders, amniotic membrane transplantation alone is not effective.

Multilayer amniotic membrane transplantation for reconstruction of deep corneal ulcers

Purpose To evaluate the efficacy of multilayer amniotic membrane transplantation for reconstruction of corneal epithelium and stroma in the context of deep corneal ulcers. Design Prospective, noncomparative, interventional case series. Participants Eleven consecutive patients with deep corneal ulcers refractory to conventional treatment; six patients had herpetic keratitis and five had other forms of neurotrophic keratitis. Intervention Multilayer amniotic membrane transplantation with kryopreserved human amniotic membrane. Main outcome measures Integrity of corneal epithelium and stroma, opacification, and appearance of grafted membrane during 12 months follow-up. Results Amniotic membrane transplantation markedly reduced ocular inflammation in all patients. Epithelium healed above all corneal ulcers within 4 weeks and remained stable in 9 of 11 patients for 1 year. Two patients with recurrent epithelial defect suffered from severe neurotrophic keratitis. Following transplantation the amniotic membranes gradually dissolved over a period of 12 months, but stromal thickness remained stable. Conclusion Amniotic membrane transplantation allows corneal surface reconstruction in patients with persistent epithelial defects. The multilayer technique is useful for treating deep corneal ulcers and even descemetoceles. Because the procedure results in stability of the ocular surface over a period of more than 12 months in most patients, it may be considered an alternative to conventional surgical techniques for ocular surface reconstruction.