Amniotic membrane transplantation: an updated clinical review for the ophthalmologist (original) (raw)
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Amniotic membrane transplantation for ocular surface pathology: long-term results
Transplantation Proceedings, 2003
Amniotic membrane transplantation has been used for Ͼ90 years for cutaneous and mucous lesions for regeneration of tissues. In recent years its effectiveness has been demonstrated in the treatment of diseases of the ocular surface. We present our experience with 53 amniotic membrane transplantations for different ocular pathologies with two different forms of implantation. The 53 cases were divided into three groups according to pathology and type of implant. Group 1 included 24 eyes with amniotic membrane grafts after resection of extensive conjunctival lesions. Group 2 included 19 eyes with amniotic membrane grafts for corneal pathology, and group 3 consisted of 10 eyes with amniotic membrane patches for corneal epithelial defects without ulceration. No intra-or postoperative complications were observed during an average follow-up period of 32 months (24 -48 months). Group 1 demonstrated rapid healing of the lesions with minimal scarring in all cases. In group 2 a favorable response was observed in 16 of 19 cases. In group 3 complete healing was achieved in only 3 of 10 cases, and the time for which the graft remained was related to the success of the treatment. The primary intention was to achieve prolonged fixation of the implant. Finally, amniotic membrane transplantation is a safe and effective technique for the treatment of different pathologies of the ocular surface. After the resection of extensive conjunctival lesions it is currently the preferred treatment. In corneal pathology, it represents an additional therapeutic alternative when conservative medical treatments fail.
Amniotic membranes in ophthalmology: long term data on transplantation outcomes
Cell and Tissue Banking, 2015
The use of amniotic membrane (AM) is a widespread clinical practice for eye surgeries and the treatment of an increasing number of ocular surface pathologies. Here we describe the AM collection methods and donor selection criteria adopted by our tissue bank to distribute 5349 amniotic membrane patches over the last 12 years for the treatment of several ocular pathologies. Specific quality control measures are described and the long term results attained using the reported procedure are presented. A case of AM utilized to treat severe ocular ulceration is also described as an example of AM transplantation. Collective data for the total amniotic membrane patches deployed to treat various ocular diseases are discussed and success rates for AM transplantations are reported. An extensive follow-up is illustrated. The results suggest that the procedures and protocols used by the Treviso Tissue Bank Foundation and Veneto Eye Bank Foundation for collection, preservation, distribution and follow-up are of an optimal standard. Accordingly, the authors conclude that the safety and efficiency of the proposed procedure for the therapeutic use of AM to treat various ocular pathologies are reproducible, with additional evidence favoring the use of AM as an alternative to conventional medical treatment for certain ocular conditions.
Amniotic Membrane transplantation for corneal surface reconstruction
To evaluate the efficacy of fresh human amniotic membrane for reconstruction in corneal surface diseases. Material and Methods: 28 eyes of 26 patients with corneal surface disorders were evaluated. Indications for AMT included bullous keratopathy (4 eyes), climatic droplet keratopathy (3 eyes), Steven Johnson syndrome (7 eyes), chemical injury (3 eyes), corneal ulcer (7 eyes), band keratopathy (2 eyes) and shield ulcers (2 eyes). Fresh amniotic membrane was used in all the cases. Result: The age range was from 18-65 years, out of which 15 were males and 11 were females. Success was noted in75% (21/28 eyes) with very few complications in an average follow up period of 6 months. The mean epithelisation time varied from 2-2.4 weeks. Conclusion: Fresh amniotic membrane can reduce inflammation, promote epithelisation and decrease in various corneal surface disorders.
Amniotic membrane transplantation in ocular surface disorders
Journal of the Indian Medical Association
The term ocular surface disorders indicate a close relationship between the conjunctival and corneal epithelium in many corneal and external diseases. The human amniotic membrane has a thick basement membrane and an avascular stromal matrix and its first ophthalmic use was reported by deRoth for conjunctival surface reconstruction. It was subsequently used for different ophthalmic reasons. Amniotic membrane transplantation can be used in a number of conditions eg, as a graft to replace damaged ocular surface stromal matrix or as a patch to prevent unwanted inflammatory insults from gaining access to the damaged ocular surface. Amniotic membrane can be utilised in persistent of recurrent corneal epithelial and stromal defects; in cases of corneal perforation due to ulcer or melting; after conjunctival excision for acquired melanosis, neoplasia, etc; in cases of pemphigoid, Stevens-Johnson syndrome, chemical bums; in cases of symblepharon, in dry eyes or in large leaking filtering blebs.
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 2017
Amniotic membrane (AM) transplantation has been used successfully worldwide in ophthalmology plastic surgery for over 100 years. This review presents the histological and the immunohistochemical features of AM compared to those of the conjunctiva and discusses the techniques of processing and preservation, its mechanism of action in ocular reconstruction, its clinical ophthalmic indications, but also advantages and limitations of grafting with this biomaterial.
Amniotic membrane transplantation for ocular surface reconstruction
British Journal of Ophthalmology, 1999
The use of amniotic membrane (or amnion) for transplantation as graft in ocular surface reconstruction is reviewed. This technique has become widespread because of the availability of the amnion, convenience and ease of use, and high and reproducible success rates. The mechanisms of action of the transplantation are varied and include the prolongation and clonogenic maintenance of epithelial progenitor cells, promotion of goblet and nongoblet cell differentiation, exclusion of inflammatory cells with anti-protease activities, suppression of Transforming Growth Factor β signaling and myoblast differentiation of normal fibroblasts. The observed clinical effects include facilitation of epithelialization, maintenance of normal phenotypes, and reduction of inflammation, vascularization and scarring. Amniotic membrane transplantation is being increasingly used as graft for various conjunctival and corneal diseases and as a patch in cases of chemical and thermal burns, refractory and recalcitrant keratitis, and most recently as an excellent substrate for expanding epithelial stem cells ex ûiûo.
Journal of Evidence Based Medicine and Healthcare, 2018
BACKGROUND Human amniotic membrane (AM) is the inner layer of the fetal membranes and consist of the epithelium, basement membrane and stroma. The AM has anti-inflammatory, anti-fibrotic, anti-angiogenic as well as anti-microbial properties. Because of its transparent structure, lack of immunogenicity and the ability to provide an excellent substrate for growth, migration and adhesion of epithelial corneal and conjunctival cells, it can be used for ocular surface reconstruction in many ocular pathologies including corneal disorders associated with limbal stem cell deficiency, surgeries for conjunctival reconstruction, as a carrier for ex vivo expansion of limbal epithelial cells, glaucoma surgeries and scleral melts and perforations. AM transplantation is a very useful armamentarium in the hands of the ophthalmic surgeons for treating a variety of ocular surface disorders caused by various Chemical, acids and alkali and also endogenous causes like severe dry eye, Steven Johnson Syndrome etc affect the ocular surface as it is a very sensitive and dynamic structure. The aim of the study is to evaluate the efficacy of Non-Preserved Human Amniotic Membrane Transplantation in ocular surface disorders with respect to re-epithelialisation, corneal clarity, degree of neovascularisation and visual outcome and compare its efficacy with that of preserved Amniotic Membrane Transplant. MATERIALS AND METHODS 40 eyes of 36 patients were subjected to amniotic membrane transplant from July 2016 to January 2018. Non-preserved amniotic membrane was employed to cover corneal ulceration due to dry eye syndrome (12 eyes), non-healing corneal ulcers (12 eyes), corneal epithelial defect due to Steven Johnson Syndrome (8 eyes), conjunctiva and corneal epithelial defect due to alkali burn (8 eyes). Amniotic membrane sutured to surrounding conjunctiva using 10-0 silk with interrupted suture. Patients were followed up to 6 months. Sutures removed on 31 st day of transplant. RESULTS Out of 40 eyes of 36 patients with mean age group of 32.5 years, non-healing corneal ulcer (8 eyes; 20%), dry eye syndrome (8 eyes; 20%) and Steven Johnson syndrome (4 eyes; 10%) showed resolution of epithelial defect and stabilization of neo vascularisation. 4 eyes (10%) of alkali burn responded favourably but retransplantation of Amniotic membrane to 2 nd eye (10%) of the same patient, on 45 th day had to be done. Over all 4 eyes of Steven Johnson syndrome, 4 eyes of dry eye syndrome, 4 eyes of persistent sterile corneal ulcer failed due to unrelated bacterial keratitis. Corneal clarity and improved visual acuity were observed in 60% of patients on day 31 st. Transplantation in 16 eyes (40%) failed and was sent to higher center for further management. CONCLUSION Non-preserved human amniotic membrane transplantation is a safe and equipotent procedure as compared to preserved amniotic membrane in ocular surface reconstruction where facilities for preservation are not available and continuing medical management bears higher risk.
British Journal of Ophthalmology, 2007
Background: Amniotic membrane transplantation (AMT), as a new tool in the armamentarium of therapies available for ocular surface problems, became widely available in the UK in 1998. This study evaluates the indications for treatment, the surgical procedures used, and the results of a subset of the first AMT cases carried out by the group using this nationally available supply. This user group model provides data which is different from that obtained from uncontrolled case series, or clinical trials, and may be more representative of the outcomes that can be expected when a procedure becomes widely available. Methods: The first 233 AMTs, performed by the UK user group, were evaluated by audit and outcomes were assessed at 3 months. Results: Of the 233 transplants, there were 126 (54.1%) valid outcome returns: the outcome for persistent epithelial defects was a healed and stable surface in 11/35 (31.4%, 95% CI 16.9 to 49.3); for chemical/ thermal injuries, a healed uninflamed eye with clear cornea in 5/18 (27.8%, 95% CI 9.7 to 53.4); for bullous keratopathy a pain-free, stable surface without bullae in 4/18 (22.2%, 95% CI 6.4 to 47.6); for ocular surface reconstruction, an epithelialised uninflamed conjunctiva without scarring in 12/23 (52.2%, 95% CI 30.6 to 73.2); and for limbal stem cell deficiency, a corneal phenotype in 4/7 (57.1%). The operative technique least associated with failure was use of a bandage contact lens at the end of the procedure (OR 0.19, 95% CI 0.06 to 0.59, p = 0.004). Previous treatment with topical steroids was significantly associated with failure (OR 5.70, 95% CI 1.77 to 18.43, p = 0.004). Conclusion: Although the outcome criteria used in this study were stringent, and the follow-up duration was short, the results of AMT by this user group were generally less favourable than those of previously reported case series. Controlled clinical trials would improve the quality of evidence for use of amniotic membrane in ocular disease.