Results Of Amniotic Membrane Transplantation Research Articles

A comparative study between amniotic membrane transplantation and topical mitomycin-C in recurrent pterygium management

Aim The aim of this study was to compare the outcome of amniotic membrane transplantation (AMT) and topical mitomycin-C (MMC) in the management of recurrent pterygia. Patients and methods This is a retrospective study that included 40 cases of recurrent pterygia. They were subjected to surgical excision of the pterygium with bare sclera technique. The cases were categorized into two groups, 20 cases in each group. Group 1 was managed with intraoperative topical MMC, while group 2 was managed with AMT at the time of surgery. The patients were followed-up for at least 6 months postoperatively. The outcome measures were visual acuity (VA), corneal astigmatism, recurrence, and postoperative complications. Results The duration of postoperative pain was significantly shorter in the AMT group (6.8±1.0 days) than in the MMC group (10.45±1.5 days, P<0.0001). In addition, postoperative photophobia and lacrimation persisted for a significantly longer period in the MMC group (mean=10.0±1.03 days) compared to the AMT group (mean=7.85±0.81 days, P<0.0001). At the end of follow-up period, VA improvement occurred in 60% of group 1 and in 70% of group 2 patients. However, the preoperative and postoperative decimal VA were not significantly different between the two study groups (P=0.6684 and 0.7302, respectively). In group 1, there was a significant difference between the preoperative corneal astigmatism [−3.74±2.19 diopter (D)] and the postoperative astigmatism (−2.31±1.46 D) after 6 months (P<0.01). Similarly, in group 2, there was also a significant difference between the preoperative corneal astigmatism (−3.83±2.32 D) and the postoperative astigmatism (−2.12±1.60 D) after 6 months (P<0.01). However, the difference between the two groups was statistically insignificant. In the first postoperative 2 weeks, there was a statistically insignificant higher incidence of delayed wound healing and superficial punctate keratitis in the MMC group. The corneal wound healing was faster in the AMT group (mean=4.2±0.69 days) than in the MMC group (mean=4.6±o.6 days). However, the difference was not statistically significant (P=0.0578). At 2 weeks postoperatively, there were two cases of conjunctival defect and one case of scleral thinning in the MMC group only. At the end of the follow-up period, another case, in the MMC group, developed scleral thinning; however, the cornea was clear. Conclusion AMT and MMC could be used in the management of recurrent pterygia. The AMT group showed better visual outcome without postoperative complications. However, the difference between the two groups was statistically insignificant.

Clinical Outcome of Amniotic Membrane Transplantation in Chemically Injured Eyes

Purpose: To evaluate the clinical outcome of Amniotic Membrane Transplantation (AMT) in chemically injured eyes for ocular surface reconstruction. Methods: A prospective study of 30 consecutive chemically injured eyes was performed from December 2022 to May 2023 in National Institute of Ophthalmology & Hospital (NIO&H), Dhaka, Bangladesh. Twenty-seven patients (30 eyes having corrosive chemical injuries) were included in the study according to the inclusion & exclusion criteria. AMT was performed within 21 days of injury by single surgeon with modified surgical procedure. Post operative evaluation was done by Snellen chart, slit lamp biomicroscope and Schirmer-II test. Results: After 3 months of AMT, there was no pain or inflammation. Improvement of vision found in 20 (66.67%) of 30 eyes, 4 (13.33%) eyes of rest 10 eyes showed inaccurate Projection of Rays (PR) vision and rest 6 (20.0%) eyes of rest 10 eyes found deteriorated vision. Epithelialization occurred in all eyes. Twenty-four (80.0%) eyes had limbal stem cell deficiency and they experienced superficial corneal vascularization. Symblepharon was seen in 18 (60.0%) eyes, 6 (20.0%) of these 18 eyes developed marked conjunctival shortening with ankyloblepharon. None of the eyes showed perforation. Conclusions: AMT increases patient comfort and reduces inflammation. In mild burns, AMT alone restores corneal and conjunctival surfaces. In moderate to severe burns, it reduces conjunctival scarring sequelae, but does not prevent the sequelae of limbal stem cell deficiency that requires further limbal stem cell transplantation. In the acute stage, AMT has a protective role against the progressive melting and perforation. J.Natl.Inst.Ophthalmol.2023;6(1): 21-26

Clinical Outcome of Amniotic Membrane Transplant in Ocular Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis at a Major Burn Unit

To analyze the clinical outcome of amniotic membrane transplantation in patients with ocular Stevens-Johnson syndrome/toxic epidermal necrolysis at a major burn unit. Retrospective, non-randomized interventional study. A retrospective chart review from April 2014 to January 2022 of 43 patients (85 eyes) at a burn center who underwent amniotic membrane transplantation (AMT) for severe ocular Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), or SJS/TEN was performed. Data regarding the clinical course and outcome were obtained. A comparison between the use of cryopreserved AMT rings (cryoAMT) and dehydrated AMT (deAMT) was also assessed. A total of 85 eyes in 43 patients underwent AMT for severe ocular SJS/TEN. Of the eyes, 72 received deAMT with symblepharon ring, whereas 13 received cryoAMT over the cornea surface. All patients had deAMT placed over the eyelid margins and palpebral conjunctivae and tucked into the fornices. The average best-corrected visual acuity (BCVA) on last follow-up examination was 20/33, 20/30, and 20/34 in all eyes, the cryoAMT group, and the deAMT group, respectively (no significant difference between groups). The most common suspected inciting agent was lamotrigine (17% of all cases). The average long-term complication score was 1.4, with no significant difference between the cryoAMT group (1.6) and the deAMT group (1.4, P=.5). Symblepharon formation was seen more in the cryoAMT group compared to the deAMT group (P < .05). The use of AMTs in severe ocular SJS/TEN greatly mitigates long-term complications and improves visual outcome. The retrospective nature of this study limits substantial conclusions regarding any significant difference in outcome between AMT treatment methods. Nevertheless, the use of cryopreserved AMT rings has a similar outcome profile compared to use of dehydrated AMTs with symblepharon ring. Further research is needed to evaluate optimal AMT techniques.

Surgical Outcome of Amniotic Membrane Transplantation (AMT) in Patients with Corneal Ulcer in Dr. M. Djamil Hospital Padang Indonesia

Surgical Outcome of Amniotic Membrane Transplantation (AMT) in Patients with Corneal Ulcer in Dr. M. Djamil Hospital Padang Indonesia

Amniotic Membrane Transplantation in the Management of Corneal Ulceration Following Infectious Keratitis

ABSTRACT Purpose To report on the outcomes of amniotic membrane transplantation (AMT) for corneal ulceration following infectious keratitis. Method In this retrospective cohort study of 654 patients with culture-proven infectious keratitis from 8 hospitals in Galicia (Spain), a total of 43 eyes of 43 patients (6.6%) underwent AMT for postinfectious corneal ulceration. The indications for AMT were sterile persistent epithelial defects, severe corneal thinning or perforation. Results AMT was successful in 62.8% of cases, with 37.2% requiring an additional surgery. Median time to healing was 40.0 days (IQR 24.2–101.7 days) and final BCVA was lower than baseline (p = 0.001). Ulcers were large (>3 mm) in 55.8% of cases. Previous herpetic keratitis and topical steroid use were more common in patients who received AMT (p < 0.001). 49 microorganisms (43 bacteria and 6 fungi) were isolated. Conclusions AMT is a therapeutic option for complications following infectious keratitis, which present with a sterile persistent epithelial defect, significant corneal thinning or perforation.

Clinical Results of the Use of Amniotic Membrane Transplantation Alone or in Combination with Adjuvant Therapies in Conjunctival Fornix Reconstruction.

Objectives:To evaluate the clinical results of amniotic membrane transplantation alone or in combination with adjuvant therapies in conjunctival fornix reconstruction.Materials and Methods:The clinical results of patients who presented to our clinic between 2002 and 2016 due to conjunctival fornix obliteration and underwent amniotic membrane transplantation alone or in combination with additional treatments were retrospectively analyzed. The Foster and Mondino classifications were used to grade fornix obliteration. In all cases, the area of conjunctival defect formed after symblepharon lysis was covered with amniotic membrane. In advanced fornix obliteration, amniotic membrane transplantation was combined with 0.04% mitomycin-C (MMC), oral mucosal transplantation, fornix formation (anchoring) sutures, symblepharon ring, eyelid surgery, fibrin glue, and limbal autograft. Deep and scarless restoration of the fornix was considered surgical success.Results:Twenty-two men and 5 women with a mean age of 45.54±4.17 years were included in the study. The etiology of fornix obliteration was mechanical trauma in 16 cases, chemical burn in 6 cases, recurrent pterygium in 3 cases, thermal burn in 1 case, and recurrent chalazion surgery in 1 case. Indications for amniotic membrane transplantation were socket insufficiency in 12 cases, cosmetic reasons in 4 cases, keratoplasty preparation in 3 cases, ptosis in 3 cases, entropion in 2 cases, strabismus in 2 cases, and diplopia in 1 case. The mean follow-up period was 45.04±8.4 months. Twenty-four of 27 cases (88.8%) were successful, while 3 (12.2%) failed due to recurrence of symblepharon.Conclusion:Amniotic membrane transplantation is a successful method when used alone in the reconstruction of early-stage conjunctival fornix obliteration and provides safe and effective results in advanced-stage fornix obliteration when performed in combination with topical 0.04% MMC, oral mucosal transplantation, and limbal autograft surgeries.

Comparison of amniotic membrane transplantation with and without cultured limbal epithelium for persistent corneal ulcers

This study compared the clinical outcomes of amniotic membrane transplantation with and without cultured limbal epithelium for persistent corneal ulcers. The study included 30 patients that were assigned to either human amniotic membrane transplantation (AMT) only or a two-step cultured limbal epithelial transplant (CLET) with amniotic membrane carrier. The patients underwent a comprehensive ocular examination, Cochet-Bonnet esthesiometry, impression cytology and anterior segment optical coherence tomography (AS-OCT). Slit-lamp images before and after treatment were analyzed using ImageJ to compare the fibrovascular tissue area. The state of epithelialization was assessed by fluorescein staining on day 30. Mean age of patients was 64 ± 20.39 in the AMT group and 55.17 ± 14.51 in the CLET group (p = 0.16). Visual acuity improved significantly in both groups after treatment, but the improvement was significantly greater in the CLET group (p = 0.022). Impression cytology demonstrated PAS + cells in the corneal epithelium in 9 patients from the CLET group and 10 patients in the AMT group (p = 0.704). Cochet-Bonnet esthesiometry increased significantly after treatment with a similar rate between groups (p = 0.435). Improvement with reduction of the fibrovascular tissue area was achieved in both groups (p < 0.01 and p = 0.001 in the CLET and AMT group, respectively). Independent samples T-test demonstrated a greater reduction in the CLET group (p = 0.028). Kaplan-Meier analysis of epithelialization demonstrated higher success rate in the CLET group (p = 0.006). Persistent corneal ulcers could be associated with partial limbal stem cell deficiency (LSCD). In refractory cases, CLET should be the preferred treatment option with more sustainable results regarding corneal epithelialization and stromal scarring.

Amniotic membrane transplantation for infectious corneal ulcer treatment: a cohort retrospective study

BACKGROUND Corneal ulcer is one of the most common causes of corneal blindness. This study aimed to describe the outcomes of amniotic membrane transplantation (AMT) in patients with infectious corneal ulcer.&#x0D; METHODS A retrospective cohort study based on medical records of patients who underwent an adjuvant AMT procedure over a 2-year period (2015–2017) was conducted at Cipto Mangunkusumo Hospital Jakarta. Uncorrected visual acuity (UCVA) was measured with the Snellen chart. Treatment success was marked by complete healing (disappearance of corneal infiltrates, epithelial defect closure, and corneal scar formation). Healing time was the duration from AMT surgery to complete healing.&#x0D; RESULTS 50 cases of infectious corneal ulcer, 12 of which had perforation were included. Gram-positive cocci (18%), gram-negative rods (14%), fungi (4%), and Acanthamoeba (2%) were isolated from culture specimens. Successful results were observed in 90% of cases (20/21 moderate cases and 25/29 severe cases). Healing time was 21 (14–63) days in moderate cases and 28 (14–90) days in severe cases. Baseline UCVA improved from 2.48 (0.22–2.80) logMAR to 1.30 (0–2.80) logMAR within 3–4 weeks postoperatively and to 0.94 (0–2.80) logMAR at the last follow-up. Post-AMT complications included recurrent perforation in 4 eyes, persistent epithelial defects in 2 eyes, amniotic membrane infection in 1 eye, and membrane retraction in 1 eye.&#x0D; CONCLUSIONS AMT was successfully used to treat moderate and severe infectious corneal ulcer, particularly in nonresponsive and some perforated cases. AMT provides biochemical and mechanical support for corneal wound healing with good visual outcomes.

Recurrence Rate and Clinical Outcome of Amniotic Membrane Transplantation Combined with Mitomycin C in Pterygium Surgery: Two-Year Follow-Up.

Objective:To evaluate the recurrence rate and outcome of pterygium surgery with amniotic membrane transplantation (AMT) and intraoperative mitomycin C (MMC).Methods:This prospective clinical study included patients with pterygium who were candidates for pterygium excision. After the surgical excision, intraoperative local MMC were applied in the standard protocol followed by AMT. The outcome measures were recurrence and the size change of lesion. Kaplan-Meier estimation and regression analyses were performed.Findings:Fifty five eyes of 55 consecutive patients including 30 male (54.5%) and 25 female (45.5%) with mean age of 47.12 ± 15.95 years were operated. The mean follow-up period was 15.21 ± 2.67 months. The overall recurrence rate was 34.5% (19/55 cases). The estimated recurrence time for larger size of pterygium before surgery was short and marginally significant (17.14 ± 0.58 month in size of ≤3.0 mm versus. 18.56 ± 0.60 month in size of <3 mm; P= 0.06). A statistically significant association was found in reduced model among the size change of the pterygium and standardized coefficient was −0.012 (P = 0.044) and −0.743 (P < 0.001) for age and size of lesion before surgery, respectively.Conclusion:Our findings suggest that increasing age and pterygial tissue are the risk factors for recurrence and pterygium has a substantial recurrence rate even after AMT combined with MMC.

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.

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.

Amniotic membrane transplantation with or without autologous cultivated limbal stem cell transplantation for the management of partial limbal stem cell deficiency.

PurposeTo compare the outcomes of amniotic membrane transplantation (AMT) vs cultivated limbal stem cell transplantation (LSCT) in eyes with partial limbal stem cell deficiency (LSCD) following chemical burns.MethodsEyes with unilateral partial LSCD (#180° involvement) were randomized in two groups to undergo either pannus resection combined with AMT or pannus resection combined with LSCT in a tertiary eye care hospital. Primary outcome measures were time to corneal epithelialization and absence of conjunctivalization of the cornea. Patients were followed up at 1 week, 1, 3, 6, and 12 months after the surgical procedure.ResultsThere was no difference between mean age (30.85±5.8 vs 28.64±6.4 years, P=0.40) and sex distribution of patients between the two groups at baseline. Mean time to corneal epithelialization was 10.45±5.8 days in the AMT group and 11±3.9 days in the LSCT group (P=0.43). At the end of 1 year, there was no significant difference between the degree of conjunctivalization of cornea, (P=0.06) corneal vascularization, (P=0.08), and clarity (P=0.07) in both groups.ConclusionOur study showed that AMT alone is a useful therapeutic modality in cases with partial LSCD due to ocular chemical injury. Stem cell transplantation may not be required in these cases.

Amniotic membrane transplantation with topical interferon alfa-2b after excision of ocular surface squamous neoplasia.

To evaluate the outcome of amniotic membrane transplantation (AMT) after tumor excision followed by topical interferon alfa-2b (IFNα2b) drops for primary ocular surface squamous neoplasia (OSSN). Twelve eyes of 12 patients with a mean age of 66±10y were included. The average follow-up was 23±10mo. All 12 patients had limbal involvement. Smooth ocular surface and transparent cornea were achieved in all cases. No sign of inflammation, neovascularization, symblepharon or recurrence was noted at the last follow-up. We conclude that AMT with topical IFNα2b drops restores a healthy ocular surface in OSSN without recurrence.

Comparison of free conjunctival autograft versus amniotic membrane transplantation for pterygium surgery

PurposeTo compare the recurrence rate and surgical outcomes of amniotic membrane transplantation (AMT) and free conjunctival autograft (CAT) for pterygium surgery. MethodsIn this prospective study, 60 patients with primary pterygium were randomly assigned to two groups of CAT or AMT and were compared in terms of recurrence rate, mean healing time of corneal epithelial defects, the mean level of inflammation, and complications. ResultsThe mean ± SD age of patients was 48.98 ± 9.8 years (range, 27–71 years). 73.3% were men, and 26.7% were women. The groups did not differ with respect to demographic characteristics (P > 0.05). Patients were followed for an average of 12.6 ± 1.3 months. The recurrence rates were 6.7% and 3.3% in the AMT and CAT groups, respectively (P > 0.05). Comparison of mean inflammation score showed higher inflammation in the AMT group in the first, third, and sixth postoperative month (P < 0.05). Mean healing times of corneal epithelial defects were 2.5 ± 0.572 and 2.67 ± 0.479 days in the CAT and AMT groups, respectively (P = 0.173). ConclusionsNo significant complication was observed during or after both surgical methods. No statistically significant difference was seen in visual acuity changes and epithelial healing in CAT and AMT groups, but more inflammation and recurrence rate were seen in AMT group.

Amniotic membrane transplants in the pediatric population

To investigate the indications for and results of amniotic membrane transplantation (AMT) for the treatment of ocular disease in pediatric patients at a single institution. The medical records of patients <18years of age who underwent AMT for ocular disease between January 1, 2003, and September 1, 2015, were reviewed retrospectively. Patients were determined to have reached a clinical endpoint if there was resolution of the ocular condition being treated after AMT placement, no additional surgery required for treatment of the ocular condition, and no active disease at most recent follow-up. A total of 48 records were reviewed. Of these, 32 patients (67%) received AMT for treatment of ocular disease related to Stevens Johnson syndrome (SJS), 29 (94%) of whom reached the clinical endpoint. The remaining 16 patients (33%) underwent AMT for indications other than SJS, including difficult-to-treat corneal epithelial defects and ulcers, conjunctival reconstruction, and scarring after strabismus surgery. Of these, 80% reached the clinical endpoint. There were no adverse effects related to AMT in either group. In our series, AMT was used successfully and without complications.

Surgical outcomes of perforated and unperforated corneal descemetocele.

To compare the surgical outcomes of amniotic membrane transplantation (AMT) and penetrating keratoplasty (PK) in perforated and non-perforated corneal descemetocele. In this study, we retrospectively examined 48 eyes of 48 patients operated with AMT, and 32 eyes of 32 patients operated with PK for perforated and non-perforated descemetocele. There were no significant differences between the two groups with regard to age, sex, laterality, follow-up duration, cause of descemetocele, and localization (p>0.05). Thirty-six (75%) eyes in the AMT group and 17 (53.1%) eyes in the PK group were perforated prior to operation (p=0.043). Surgical success was achieved in 35 (73%) of 48 eyes underwent AMT and 28 (87.5%) of 32 eyes underwent PK (p=0.118). Perforation size was the only parameter significantly affecting surgical success (AMT p=0.001, PK p=0.003). The visual acuity was significantly better at the postsurgical period compared to the presurgical period in both groups (p=0.003, p<0.001). It was observed that the postsurgical change in the visual acuity score was significantly greater in the PK group (p=0.001). Penetrating keratoplasty is superior to AMT for achieving ocular surface integrity and enhancing visual acuity. Amniotic membrane transplantation saves time for patients and surgeons when donor cornea supply is limited and it allows PK to be performed at a quiet period when inflammation is suppressed.

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

Clinical outcomes of amniotic membrane transplantation in the management of acute ocular chemical injury

BackgroundAmniotic membrane transplantation (AMT) has been used in the management of acute ocular chemical burns to promote epithelialisation, reduce inflammation and restore ocular surface integrity. The aim of this study...

Long-term outcome of amniotic membrane transplantation combined with mitomycin C for conjunctival reconstruction after ocular surface squamous neoplasia excision.

The aim of the study is to evaluate the long-term clinical results of amniotic membrane transplantation (AMT) combined with mitomycin C (MMC) for reconstruction of conjunctival defects created during the excision of ocular surface squamous neoplasia (OSSN). Eight consecutive eyes of seven patients (five males and two females; mean age, 64±19years) treated by one surgeon (KH) were included in this study. AMT was performed after excision of a mass region, along with 0.04% MMC treatment for the exposed sclera. The tumor size, histopathological retrieval, AM graft size after tumor excision, recurrence, and postoperative complications were recorded. During a mean postoperative follow-up period of 60.9±14.6months (range 36-78months), the ocular surfaces completely re-epithelialized in all cases. The median size of the tumor was 44.4±21.2mm2 (range 13-67mm2). The histopathological diagnoses were five cases of squamous cell carcinoma in situ (SCC in situ) and three cases of dysplasia. The median size of the AM graft after tumor excision was 100.8±32.7mm2 (range 49-151mm2). A case of recurrent SCC in situ with a preoperative history of using MMC eye drops developed further corneal limbal deficiency and was treated with therapeutic soft contact lenses. A case of dysplasia with a history of large pterygial excision developed symblepharon postoperatively was treated with AMT 6months after tumor excision. The tumors recurred in two eyes with SCC in situ and were successfully treated with continuous AMT and MMC. No severe complications, such as infections, corneal or scleral thinning, or ulceration developed in all cases. The combination of AMT and MMC is effective for safe reconstruction over the long-term after the excision of OSSN with postoperative careful observation and treatment. In recurrent tumor excision cases, AMT is a suitable technique for repeated ocular surface reconstruction.

Long-term Outcomes of Amniotic Membrane Transplantation in Contact Lens-Induced Pseudomonas Keratitis with Impending Corneal Perforation.

Purpose:To report the anatomical and visual outcomes of double layered amniotic membrane transplantation (AMT) in eyes with advanced Pseudomonas keratitis leading to Descemetocele formation.Methods:This prospective interventional case series included 6 eyes of 6 female patients with pseudomonas keratitis caused by contact lens-induced infection who underwent double layered AMT. Surgery was performed after the ulcers were found to be poorly responsive to antibiotics, and severe thinning or Descemetocele had developed. All patients underwent a complete examination pre- and postoperatively, as well as anterior segment optical coherence tomography (OCT) and pachymetry or Orbscan after the procedure.Results:Mean follow-up period was 24 months. There was neither frank corneal perforation nor a need for emergent corneal transplantation in any of the eyes. All patients had visual acuity of hand motions before the procedure which improved to 20/50 to 20/30 three months after surgery. No surgical or postoperative complication occurred in this series.Conclusion:Double layered AMT may result in acceptable anatomical outcomes in patients with advanced Pseudomonas keratitis with Descemetocele formation and can eliminate the need for emergent corneal transplantation.