AMT for Controlling Inflammation and Promoting Healing
For acute chemical burns, acute Stevens-Johnson Syndrome, and Toxic Epidermal Necrolysis
SJS before AMT SJS after AMT
To cover both corneal and conjunctival surfaces, secure a large piece of amniotic membrane (AM) (AMNIOGRAFT® size 3.5 x 3.5 cm) to the skin surface of the upper lid margin using a 10-O nylon suture in an interrupted or running manner. Push the AM up into the upper fornix with a muscle hook and use a double-armed 4-O black silk suture in a mattress fashion to secure the AM to the skin surface with a bolster made of butterfly tubing. The remaining AM is spread to cover the upper bulbar conjunctiva and a part of the upper corneal surface.
A second large piece of AM (AMNIOGRAFT® size 3.5 x 3.5 cm) is secured to the lower lid with 10-O nylon sutures in the same manner to cover the lower fornix. The second piece of AM will overlap the first piece of AM on the corneal surface.
A temporary tarsorrhaphy is added to minimize the lid fissure if there is an exposure concern due to large scleral show or infrequent blinking as a result of a neurotrophic state (see Figure- Schematic Drawing/Video).
To cover only the corneal surface, AM (AMNIOGRAFT® 2.5 x 2.0 cm size) is secured using a 10-0 nylon suture at 2 to 3 mm from the limbus in a purse-string running fashion for a total of 8 to10 episcleral bites. The AM will cover the corneal surface like a biological bandage lens. Alternatively, PROKERA™ can be inserted following topical anesthetic eye drops and insertion of a lid speculum (see video for insertion and removal).
Videos
Acute Treatment for Severe Ocular Surface Inflammation Overview Video: Overview of the surgical use of amniotic membrane in the acute stage of chemical burns and Stevens-Johnson Syndrome OSREF Severe Ocular Surface Inflammation Treatment Overview
Surgical Treatment of Acute Chemical Burn with Amniotic Membrane Video 1: Video of the surgical procedure for the acute treatment of a chemical burn using amniotic membrane with sutures followed by post-operative discussion OSREF Chemical Burn Surgery Sample 1
Treatment of Acute Chemical Burn with Amniotic Membrane Video 2: Video of the clinical results achieved utilizing PROKERA in the office for treatment of an acute chemical burn without surgery OSREF Chemical Burn Treatment Sample 2
Papers
Click here to view PubMed.gov's list of papers published on Amniotic Membrane for Chemical Burns. (To update this list, click the "Go" button next to the search box at the top of the screen.)
Click here to view standard surgical supplies used for AMT.
Click here to view standard Post-operative care for AMT
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