Corneal tattooing to mask subsequent opacification after amniotic membrane grafting for stromal corneal ulcer.

• Lee JE,
• Jun JB,
• Choi HY,
• Oum BS,
• Lee JS.

Department of Ophthalmology, College of Medicine, Pusan National University, Pusan, Korea.

PURPOSE: We aimed to report on the cosmetic efficacy of corneal tattooing using India ink for resolving corneal opacities resulting from amniotic membrane grafting carried out to promote corneal wound healing in stromal corneal ulcers. METHODS: Amniotic membrane grafting of corneal ulcers was carried out in three patients. After corneal re-epithelialization, a 30-gauge needle filled with India ink was placed into the amniotic membrane space located between the regenerated corneal epithelium and the stromal bed. The ink was then carefully injected. RESULTS: The cornea was successfully stained with India ink in all cases. There were no significant complications during the mean follow-up period of 17 months. All the patients were satisfied with the corneal staining. CONCLUSION: When a corneal opacity occurs after an amniotic membrane graft for stromal corneal ulcer, corneal tattooing by intrastromal injection of India ink into the amniotic membrane space may be a very useful method of achieving a good cosmetic result.

PMID: 16965504 [PubMed - indexed for MEDLINE]

[Diseases of the adnexa in the tropics: amnion membrane transplantation for noninfectious trachoma-associated corneal ulcers]

• Bialasiewicz AA,
• Shenoy R,
• Al-Muniri A,
• Thakral A.

Department of Ophthalmology and School of Ophthalmic Technicians, College of Medicine and Health Sciences of the Sultan Qaboos University, 123 Al Khod, Muscat, Oman. alexander@squ.edu.om

BACKGROUND: Corneal ulcers with fornix shortening associated with late stages of cicatrizing trachoma contribute significantly to blindness in many developing countries. We report on the outcome of ocular surface and fornix reconstruction using amnion membrane transplantation. PATIENTS AND METHODS: From 2001 to 2005, cryopreserved human amnion membrane without mitomycin C was grafted to 25 eyes of 17 patients with trophic corneal ulcers and symblepharon (cicatrizing trachoma: 19 eyes of 14 patients, Stevens-Johnson syndrome: 4 eyes of 2 patients, alkali burns: 2 eyes of 1 patient) in a controlled case series. Follow-up was done up to 6 months. STATISTICS: Fischer's exact probability test. RESULTS: Of 25 eyes, 9 of 19 eyes with trachoma, 3 of 4 eyes with Stevens-Johnson syndrome, and 2 of 2 eyes with chemical burns showed complete reepithelialization and stromal recovery after 28-35 days (mean: 31+/-2.3 days). The primary success rate of trachoma eyes was not significantly different from the other indications (p=0.256). At 6 months post-op, 15 of 19 trachoma eyes (79%) compared to 2 of 6 non-trachoma eyes (33.3%) had developed a recurrence of symblephara (p=0.0592), and 13 of 15 eyes (86.6%) with a cicatricial trachoma compared to 1 of 6 with non-trachoma diagnosis experienced a recurrence of corneal vascularization (difference nonsignificant: p=0.1752). Persistent long-term reepithelialization was observed only in 1 of 19 trachoma eyes (5.3%) versus 4 of 6 non-trachoma eyes (66.7%, p=0.005); 3 of 19 trachoma eyes with a recurrence of ulcers had perforated after 6 months. CONCLUSIONS: Human amnion membrane without mitomycin C can be used for ocular surface reconstruction in selected patients with cicatrizing trachoma. Its efficacy in the long-term rehabilitation of cicatrizing trachoma seems to be limited due to the progressive scarring.

PMID: 16847650 [PubMed - indexed for MEDLINE]

Use of fibrin glue in fixation of amniotic membranes in sterile corneal ulceration.

• Uhlig CE,
• Busse H,
• Groppe M.

University Eye Hospital Muenster, Muenster, Germany. uhligc@uni-muenster.de

PURPOSE: To describe a method of fibrin glue fixation of single or multilayered amniotic membranes in sterile corneal ulceration. DESIGN: A modified microsurgical procedure. METHODS: The corneal ulcer is cleaned and the components of fibrin glue are applied separately. Amniotic membranes are rotated through the fibrinogen component and subsequently into the site of the ulceration where thrombin is already applied. An overlay membrane is sutured additionally on top. The results for one patient are illustrated as an example. RESULTS: The application technique prevents development of foam and leads to a thin fibrin film, which minimizes any irregularities of the fixed membranes and creates extra time to adjust the membranes' position. CONCLUSIONS: This method presents as an effective procedure for the treatment of sterile corneal ulceration and creates valuable time if any elective corneal graft procedure is required.

PMID: 16815284 [PubMed - indexed for MEDLINE]

Amniotic membrane transplantation for persistent corneal ulcers and perforations in acute fungal keratitis.

• Chen HC,
• Tan HY,
• Hsiao CH,
• Huang SC,
• Lin KK,
• Ma DH.

Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

PURPOSE: To report the therapeutic effect and complications of amniotic membrane transplantation (AMT) in acute fungal keratitis. METHODS: Diagnosis of fungal keratitis was confirmed by cultures in 23 eyes of 23 patients. The indications to perform AMT were to promote reepithelialization in non-healing ulcers or to prevent corneal perforation. Antifungal agents were administered throughout the whole course of hospitalization. Repeated cultures were performed immediately before AMT. The main outcome measurements were epithelial healing rate, necessity of therapeutic penetrating keratoplasty (TPK), and persistence of infection. RESULTS: During a mean follow-up time of 20.6 months +/- 23.22 (6-65 months) AMT was performed during the active phase of the keratitis (fungal culture was still positive) in 16 patients (69.6%), and during the inactive phase (fungal culture negative) in 7 patients (30.4%). Single-layer AMT was performed in 17 patients, and double-layer AMT was performed in 6 patients with corneal perforation and anterior chamber collapse. Complete epithelialization was observed in 12 patients (75%) in the active group and in 7 patients (100%) in the inactive group. Treatment failure requiring TPK was experienced in 4 patients (25%) in the active group. Persistent fungal keratitis was noted in 2 patients (8.7%) in that group. The final visual acuity improved in 17 cases, worsened in 2 cases, and remained unchanged in 4 cases. Twelve of the 23 eyes (52.2%) in this study preserved useful vision (20/400 and better) with or without subsequent surgeries. CONCLUSION: AMT is effective in promoting epithelialization and preventing corneal perforations in acute fungal keratitis, and there is no risk of rejection. However, the risk of persistent or recurrent infection necessitates continued antifungal treatment and patient monitoring.

PMID: 16783145 [PubMed - indexed for MEDLINE]

The results of amniotic membrane transplantation for symptomatic bullous keratopathy.

• Chansanti O,
• Horatanaruang O.

Department of Ophthalmology, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand. Ting1601@hotmail.com

OBJECTIVES: To evaluate the outcomes of amniotic membrane transplantation for symptomatic relief in patients with bullous keratopathy. MATERIAL AND METHOD: This retrospective study included 17 eyes (17 patients) with bullous keratopathy presenting with intractable pain or discomfort. The patients were enrolled from January 2000 to December 2004. Amniotic membrane transplantation was performed. Symptomatic relief epithelial healing, and visual changes were analyzed. RESULTS: During the follow up period of 14.1 +/- 11.9 months (range 1-36 months) after amniotic membrane transplantation, 14 eyes of 17 eyes (82.4%) with intolerable pain preoperatively had pain relief postoperatively. Corneal epithelial healing was complete in all except 2 eyes one of which had evisceration because of severe corneal ulcer, and the other underwent penetrating keratoplasty soon after amniotic membrane transplantation. CONCLUSION: Amniotic membrane transplantation is a safe and effective treatment modality for pain relief associated with chronic bullous keratopathy. It can be an alternative to conjunctival flap, with better cosmetic appearance for the management of patients with bullous keratopathy.

PMID: 16681053 [PubMed - indexed for MEDLINE]

Combination of serum eye drops with hydrogel bandage contact lenses in the treatment of persistent epithelial defects.

• Schrader S,
• Wedel T,
• Moll R,
• Geerling G.

Department of Ophthalmology, UK-SH Campus Lubeck, Klinik fur Augenheilkunde, Ratzeburger Allee 160, 23538, Lubeck, Germany. mail@stefanschrader.de

BACKGROUND: The treatment of persistent epithelial defects (PED) with autologous serum eye drops is often combined with conventional medication such as artificial tears and topical antibiotics, but until now no report exists on the use of a bandage contact lens (BCL) in combination with autologous serum eye drops in the treatment of PEDs. We report six eyes (five patients) which were all treated with autologous serum eye drops in combination with an FDA group IV hydrogel contact lens. METHODS: Five patients aged 36-88 years, were suffering from six PEDs for 73.5+/-46.9 days due to rheumatoid sterile corneal ulcer (n=1), neurotrophic keratopathy (n=3) or partial limbal stem cell deficiency (n=1). All patients had been unsuccessfully treated with conventional therapy before. Three of them had already had an amniotic membrane transplantation and two had undergone a keratoplasty; however, the epithelial defect persisted or recurred. In all cases, an FDA group IV hydrogel contact lens (Biomedics 55, ocufilcon D, 55% water content) was fitted and serum eye drops applied 8 times a day. RESULTS: The PED healed in five of six eyes after a treatment period of 14.2+/-8.9 days. In one eye the PED became smaller, but it took 90 days until the lesion healed completely. In three eyes (two patients) white deposits appeared on the surface of the BCL during the treatment after 12.3+/-5.1 days. Because no signs of inflammation were observed and since the epithelial defect improved, a new identical lens was applied and the medication continued unaltered. The surface of contaminated and non-contaminated BCLs were analyzed by scanning electron microscopy and SDS gel-electrophoresis. The scanning electron microscopic examination presented a coating of amorphous material with a wrinkled appearance and many corpuscular deposits. There was no indication of bacterial colonisation. The SDS gel-electrophoresis showed a small band at 65 kDa, probably albumin. CONCLUSION: These findings suggest that the combination of a therapeutic contact lens and serum eye drops can be successfully used in the treatment of persistent epithelial defects. Deposition of albumin may occur on the surface of the contact lenses, which, in the small group presented here, caused no unwanted effects.

PMID: 16544115 [PubMed - in process]

[Multilayer amniotic membrane transplantation for treatment of necrotizing herpes simplex stromal keratitis]

• Shi WY,
• Chen M,
• Wang FH,
• Zhao J,
• Ma L,
• Xie LX.

Shandong Eye Institute & Qingdao Eye Hospital, Qingdao 266071, China.

OBJECTIVE: To evaluate the efficacy of multilayer amniotic membrane transplantation (AMT) combined with antivirus and corticosteroid drug to treat necrotizing herpes simplex stromal keratitis. METHODS: Thirteen patients (13 eyes) of necrotizing stromal keratitis were referred to Shandong Eye Institute and Qingdao Eye Hospital between January 2003 and April 2004. The course of disease was 3 - 22 months (mean 15 months). Corneal inflammation persisted and corneal ulcer progressed despite topical and systemic antiviral treatment for over 1 weeks. Multilayer amniotic membrane transplantation was performed after excluding of bacterial and fungal infection by microbiologic studies including smears and cultures of necrotic corneal tissue and confocal microscope. Topical and systemic antiviral medications were given with adjuvant corticosteroid eyedrops postoperatively. We investigated the healing of corneal ulcer and improvement of stromal edema with slit lamp biomicroscope, the integrity of corneal defect with fluorescein staining, the migration of healthy corneal epithelial cells and transformation of amniotic membrane with confocal microscopy. All patients were followed up for 3 - 13 months (mean 10 months). RESULTS: Corneal ulcer healed within 1 - 3 weeks postoperatively with negative fluorescein staining. Corneal stromal edema faded away within 1 month. Superficial amniotic membrane patches dissolved or shed on postoperative day 7 - 10, while the deeper grafts were adhered into the ulcer and fused with the surrounding fibroblasts. One of these grafts remained in situ more than 3 months. Confocal microscope examination indicated flat epithelial progenitor cells on the surface of residual amniotic membrane. Corneal transparence was achieved in 7 eyes, macula in 4 eyes and leucoma in 2 eyes 3 months after the operation. No recurrence of necrotizing stromal keratitis was occurred in 13 patients during the follow-up period. CONCLUSION: Multilayer AMT combined with antivirus and corticosteroid treatment is an effective method to treat necrotizing herpes simplex stromal keratitis.

PMID: 16409765 [PubMed - in process]

Equine amniotic membrane transplantation for corneal ulceration and keratomalacia in three horses.

• Lassaline ME,
• Brooks DE,
• Ollivier FJ,
• Komaromy AM,
• Kallberg ME,
• Gelatt KN.

Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610-0126, USA. lassalinem@hotmail.com

PURPOSE: Amniotic membrane has antifibrotic, anti-angiogenic and antiprotease properties. This retrospective study was designed to investigate the use of equine amniotic membrane transplants (AMT) at preserving vision, maintaining the structural integrity of the globe and maximizing cosmesis in equine eyes with corneal ulceration and severe keratomalacia. METHODS: Equine amnion had previously been aseptically harvested from a 12-year-old Thoroughbred mare during an elective Cesarean section. Sections of amnion were stored at -80 degrees C and thawed as needed. Records of equine cases at the University of Florida with keratomalacia that received an AMT without adjunctive conjunctival grafting were examined. Clinical description, details of medical and surgical treatment, globe survival and visual outcome were documented. Etiologies were determined by cytology, culture or histology. RESULTS: Three horses with corneal ulceration and severe keratomalacia received an AMT without conjunctival graft between December 2002 and April 2003. Pseudomonas spp. were cultured from all three eyes, with evidence of a concurrent fungal infection in two eyes. The three ulcers were 50, 72, and 76% of corneal diameter, and each one worsened in the face of aggressive medical therapy. In all three cases, the AMT sloughed over a 4 to 6-week period. At last follow-up, all three eyes receiving AMT were comfortable and receiving no medication, with light perception and an inconsistent location-dependent menace response. All three horses returned to their prior work. CONCLUSIONS: Results of a small number of equine AMT suggest that amnion can be used successfully to preserve both globe structure and limited vision, as well as optimize cosmesis, in horse eyes with corneal ulceration and severe keratomalacia.

PMID: 16178841 [PubMed - indexed for MEDLINE]

Amniotic membrane transplantation in refractory neurotrophic corneal ulcers: a randomized, controlled clinical trial.

• Khokhar S,
• Natung T,
• Sony P,
• Sharma N,
• Agarwal N,
• Vajpayee RB.

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, India.

PURPOSE: This study was designed to compare and evaluate the efficacy of amniotic membrane transplantation with the conventional management (tarsorrhaphy and bandage contact lens) in eyes with refractory neurotrophic corneal ulcers. METHODS: Thirty eyes of 30 patients (14 females and 16 males) with neurotrophic corneal ulcers refractory to medical management were included and divided randomly 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. The outcome parameters evaluated were epithelialization time, duration of healing of corneal ulcers, and improvement in best corrected visual acuity. RESULTS: The mean age in our study was 37 +/- 14.71 years. At the end of 3 months follow-up, 10 of 15 patients (66.67%) in group 1 showed complete epithelialization and subsequent healing and 11 of 15 patients (73.33%) in group 2 showed complete epithelialization and healing (P > 0.05). The median time for complete epithelialization was 21 days in both groups. Both groups showed an improvement in the best-corrected visual acuity. CONCLUSIONS: Both amniotic membrane transplantation and conventional management (tarsorrhaphy or bandage contact lens) are effective treatment modalities for refractory neurotrophic corneal ulcers.

PMID: 16015082 [PubMed - indexed for MEDLINE]

Suspension made with amniotic membrane: clinical trial.

• Bonci P,
• Bonci P,
• Lia A.

Department of Ophthalmology, Eye Bank, S. Maria della Scaletta Hospital, Imola (BO) - Italy.

PURPOSE: To investigate if a suspension made with amniotic membrane could have a beneficial effect on ocular surface diseases. METHODS: In the Imola branch of the Eye Bank of Emilia Romagna, the authors prepared a suspension containing homogenized amniotic membrane previously conserved at -80 degrees Celsius. Subsequently, the authors gave this preparation to 21 patients: 8 had undergone lamellar keratoplasty, 4 had undergone penetrating keratoplasty, 2 had undergone photorefractive keratectomy with a delay of epithelialization, 3 had neurotrophic corneal ulcers, 2 had corneal burning, 1 had torpid corneal ulcer, and 1 had Sjogren syndrome. Each patient had been treated with conventional therapy for at least, 4 months without any clinical improvement. In this sample of eyes the authors evaluated the transparency and integrity of epithelium before and after the therapy by means of a fluorescein staining test, examining the area of epithelial defect as well as the phlogistic situation and the symptoms referred by patients. Nine eyes from this group of patients were studied by impression cytology before and after 3 months of use of suspension. The follow-up was 5 months of once-weekly visits. RESULTS: In all patients, after 15 to 30 days the corneas became negative to fluorescein staining test and the epithelium seemed more complete and regular, there was an evident decrease of phlogistic situation in the conjunctiva, and an improvement of symptoms was referred by patients. The situation was stable during the whole follow-up. No side effects were noted. The impression cytology repeated 3 months after the treatment showed a significant corneal recovery of the cytologic situation with an important decrease of CK19+ cells on the corneal surface. CONCLUSIONS: This new therapy, which is less traumatic than an implant of amniotic membrane, is safe, and can be repeated for a long period, could help patients with corneal superficial defects.

PMID: 16001374 [PubMed - indexed for MEDLINE]

Amniotic membrane transplantation and fibrin glue in the management of corneal ulcers and perforations: a review of 33 cases.

• Hick S,
• Demers PE,
• Brunette I,
• La C,
• Mabon M,
• Duchesne B.

Department of Ophthalmology, University of Liege, Belgium.

PURPOSE: To evaluate the efficacy of amniotic membrane in corneal ulcers refractive to conventional treatment and amniotic membrane with fibrin glue in corneal perforations. METHODS: Amniotic membrane transplantation (AMT) was performed in 33 eyes from 32 patients for corneal ulcers refractive to conventional treatment. Fourteen ulcers were perforated and received fibrin glue and amniotic membrane. Ulcers were divided into 3 groups: neurotrophic or exposure, autoimmune, and other etiology. RESULTS: Overall success was observed in 80% (27/33 eyes) of the cases, with success rates of 87.5% (14/16 eyes), 70% (7/10 eyes), 85.7% (6/7 eyes) in groups 1, 2, and 3, respectively. The ulcers healed in a mean time of 3.6 +/- 1.6 weeks and the follow-up was 14.8 +/- 9.9 months. Failure was noted in 6 eyes with severe neurotrophic keratitis, Stevens-Johnson syndrome, ocular cicatricial pemphigoid, and Acanthamoeba keratitis. Grafts with fibrin sealant showed a success rate of 92.9 % (13/14 eyes) compared to 73.7% (14/19 eyes) for amniotic grafts alone. In patients with severe limbal damage, a success rate of only 20% (1/5) was observed. CONCLUSIONS: AMT is a viable option in the treatment of nonhealing corneal ulcers of various depth and etiologies. Perforations up to 3 mm can be safely managed by fibrin glue and AMT. These techniques lead to rapid reconstruction of the corneal surface and can give a good final functional result or allow keratoplasty to be done in more favorable conditions.

PMID: 15829790 [PubMed - indexed for MEDLINE]

Amniotic membrane transplantation associated with conjunctival peritomy in the management of Mooren's ulcer: a case report.

• Lambiase A,
• Sacchetti M,
• Sgrulletta R,
• Coassin M,
• Bonini S.

Interdisciplinary Center for Biomedical Research (CIR), Laboratory of Ophthalmology, University of Roma Campus Bio-Medico, Roma, Italy. a.lambiase@unicampus.it

PURPOSE: To report the association of conjunctival peritomy with amniotic membrane transplantation (AMT) at the limbus with the exclusion of the central cornea in order to preserve visual function in one case of bilateral Mooren's ulcer. METHODS: A 36-year-old man with bilateral Mooren's ulcer was unresponsive to conventional therapy. Surgical procedure was performed on his right eye, at impending risk of corneal perforation. A 20 x 20 mm piece of amniotic membrane (AM) was prepared by performing a central hole of 7.5 mm diameter with a manual trephine. A 360 degrees conjunctival peritomy was performed and the AM was placed with the epithelium side facing up and the central hole was sutured on the paracentral cornea. RESULTS: Two weeks after surgery, while the right eye showed improvement of signs and symptoms and unchanged best-corrected visual acuity (BCVA), the left eye showed a peripheral corneal perforation with prolapsed iris that required conjunctival flap. At 7 months of follow-up, the right eye showed no ocular inflammation, a reduction of the lipid-like peripheral corneal infiltrates, an increased stromal thickness, and an unchanged BCVA. The progression of corneal thinning in the left eye led the authors to perform AMT (as described) in the left eye as well. Five months after the AMT in the left eye, neither eye shows signs of disease progression, and neither requires further therapy. CONCLUSIONS: Conjunctival peritomy associated with AMT may be an alternative surgical approach in the management of Mooren's ulcers to control the inflammation and the progression of disease.

PMID: 15812773 [PubMed - indexed for MEDLINE]

[Implantation of preserved human amniotic membrane for the treatment of shield ulcers and persistent corneal epithelial defects in chronic allergic keratoconjunctivitis]

• Rouher N,
• Pilon F,
• Dalens H,
• Fauquert JL,
• Kemeny JL,
• Rigal D,
• Chiambaretta F.

Service d'Ophtalmologie, Hopital Gabriel Montpied, CHRU Clermont-Ferrand, Place Henri Dunant, 63000 Clermont-Ferrand Cedex, France. nicolas.rouher@infonie.fr

PURPOSE: To determine whether amniotic membrane implantation is a safe and effective alternative treatment for shield ulcers and persistent corneal epithelial defects associated with ulcers in chronic allergic keratoconjunctivitis (vernal or atopic keratoconjunctivitis). METHODS: Amniotic membrane implantation was performed in four consecutive patients with persistent corneal epithelial defects or vernal plaques unresponsive to conventional medical treatment lasting an average of 18 weeks. Surgery was done under general anesthesia using amniotic membrane as a therapeutic contact lens. RESULTS: A significant decrease in symptoms and complete reepithelialization of the corneal ulcers were observed in all cases within the first 7 days. These remained stable during a mean follow-up of 12 weeks, with no intraoperative or postoperative complications. Early detachment occurred in all cases with no negative consequences on ulcer healing. CONCLUSION: Patients with severe chronic allergic keratoconjunctivitis derive benefits from amniotic membrane implantation used as a therapeutic contact lens in the treatment of persistent corneal epithelial defects and vernal plaques unresponsive to conventional medical treatment.

PMID: 15687918 [PubMed - indexed for MEDLINE]

[Conservative and surgical treatment of neurotrophic keratopathy]

• Seitz B,
• Gruterich M,
• Cursiefen C,
• Kruse FE.

Augenklinik mit Poliklinik, Universitat Erlangen-Nurnberg, Erlangen. berthold.seitz@augen.imed.uni-erlangen.de

Neurotrophic keratopathy is one of the most challenging conditions among the disorders of wound healing of the ocular surface. In addition to bilateral assessment of corneal sensitivity, tear status and lid function must be analyzed and treated by unpreserved artificial tears and adequate lid surgery. Further conservative treatment options include hyaluronic acid and dexpanthenol as well as autologous serum. Application of recombinant growth factors (especially NGF) represents an interesting perspective. Concerning surgical interventions, temporary or permanent occlusion of the lacrimal punctum may be accompanied by lateral tarsorrhaphy which is easy to perform, potentially reversible, and in most cases successful. Depending on the type of wound healing disorder amniotic membrane transplantation may be helpful either as basal membrane transplant (graft) or as a patch, or in combination (sandwich). A tectonic keratoplasty a chaud should typically be combined with a simultaneous amniotic membrane patch and/or a lateral tarsorrhaphy to avoid persistent epithelial defects.

PMID: 15622497 [PubMed - indexed for MEDLINE]

[Neurotrophic keratitis. Problem child among corneal diseases]

• Seitz B,
• Kruse FE.

Augenklinik mit Poliklinik, Universitat Erlangen-Nurnberg, Erlangen.

PMID: 15616815 [PubMed - indexed for MEDLINE]

Amniotic membrane graft: histopathological findings in five cases.

• Tosi GM,
• Traversi C,
• Schuerfeld K,
• Mittica V,
• Massaro-Giordano M,
• Tilanus MA,
• Caporossi A,
• Toti P.

Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy.

Amniotic membrane transplantation (AMT) is an effective treatment for ocular surface reconstruction; however, the mechanisms through which amniotic membrane (AM) exerts its effects as well as its fate after transplantation have not been entirely elucidated and have been investigated only in part. We evaluate the integration of AM in the host cornea in five patients who underwent AMT as the result of Bowen's disease, band keratopathy, radio- or cryotherapy-induced keratopathy, chemical burn or post-herpetic deep corneal ulcer with descemetocele. Due to persistent opacification in four cases and a progressing tumor in one case, penetrating keratoplasty (PK) and enucleation were performed as early as 2 months and up to 20 months after AMT. The corneas were analyzed histopathologically. To evaluate AM remnants, corneas were stained with periodic acid Schiff's reaction (PAS), Alcian blue, and Gomory and Masson trichrome; immunostaining including collagens III and IV antibodies was also performed. None of the corneas showed remnants of AM. In all cases, we observed discontinuity of Bowman's membrane. In three cases, the corneal epithelium was completely restored, ranging from three to six cell layers. In the other two cases, we detected an intense inflammatory reaction with rich neovascularization; the epithelial surface of the central cornea was completely restored, while at the periphery of the cornea goblet mucus-producing cells were present. Although clinically useful in all cases, restoration of a stable corneal epithelium through AMT is limited by the extent and severity of limbal stem cell deficiency (LSCD). The lack of histologically documented AM remnants in our cases seems to explain the efficacy of AMT more through its biological properties than through its mechanical properties. 2004 Wiley-Liss, Inc.

PMID: 15481059 [PubMed - indexed for MEDLINE]

Dramatic healing of an allergic corneal ulcer persistent for 6 months by amniotic membrane patching in a patient with atopic keratoconjunctivitis: a case report.

• Takano Y,
• Fukagawa K,
• Miyake-Kashima M,
• Tanaka M,
• Asano-Kato N,
• Dogru M,
• Tsubota K,
• Fujishima H.

Department of Ophthalmology, Tokyo Dental College, Chiba, Japan. RXN12332@nifty.ne.jp

PURPOSE: To present a case of allergic corneal ulcer in a patient with atopic keratoconjunctivitis (AKC) that was persistent for 6 months and healed by amniotic membrane patching. CASE REPORT: A 27-year-old male patient with a corneal ulcer associated with AKC persistent for 6 months despite conventional treatment underwent amniotic membrane patching. On removal of the amniotic membrane patch after 1 week, the corneal ulcer that had been persistent for 6 months had healed completely. CONCLUSION: We experienced a case with corneal ulcer that was persistent for 6 months and healed dramatically within 1 week with improved vision and corneal clarity. In such severe and persistent cases requiring rapid epithelialization, amniotic membrane should be considered as an adjunct to conventional therapy.

PMID: 15448501 [PubMed - indexed for MEDLINE]

Multilayer amniotic membrane transplantation in the treatment of corneal perforations.

• Rodriguez-Ares MT,
• Tourino R,
• Lopez-Valladares MJ,
• Gude F.

Anterior Segment Unit, Department of Ophthalmology, Hospital de Conxo-Complejo Hospitalario Universitario de Santiago, Universidad de Santiago de Compostela, Spain. trares@usc.es

PURPOSE: To determine if multilayer amniotic membrane transplantation (AMT) is useful in the treatment of corneal perforations, and in particular to assess to what extent efficacy is affected by perforation size. METHODS: Fifteen patients (15 eyes) with corneal perforations of different sizes were divided into 3 groups: group A (microperforation, 6 eyes), group B (0.5-1.5 mm, 4 eyes), and group C (>1.5 mm, 5 eyes). The corneal perforation was caused by autoimmunity-related ulcer (3 eyes), neurotrophic ulcer (9 eyes), infectious keratitis (1 eye), or postkeratoplasty ulcer (2 eyes). Two layers of AM (for microperforations) or 3-4 layers (for the other groups) were trimmed to the size of the ulcer and sutured in place with interrupted 10-0 nylon sutures. In all cases, a bandage contact lens was then applied. RESULTS: Mean epithelialization time was 3.7 weeks (range 2-6). Mean time to recovery of corneal stroma thickness was 10.1 weeks (range 7-15). In all cases, ocular inflammation subsided within 2-5 weeks. The treatment was judged successful in 73% (11/15) of eyes. Three of the 4 unsuccessful treatments were of perforations 3 mm or more in diameter; of the 5 eyes with perforations of more than 1.5 mm in diameter, only 2 were treated successfully. CONCLUSIONS: These results suggest that multilayer AMT is effective for treating corneal perforations with diameter less than 1.5 mm. The technique may be a good alternative to penetrating keratoplasty, especially in acute cases in which graft rejection risk is high.

PMID: 15256996 [PubMed - indexed for MEDLINE]

Application of Preserved Human Amniotic Membrane for Corneal Surface Reconstruction.

• Prabhasawat P,
• Kosrirukvongs P,
• Booranapong W,
• Vajaradul Y.

Department of Ophthalmology; The Bangkok Biomaterial Center, Faculty of Medicine, Siriraj Hospital, Madhidol University, Bangkok 10700, Thailand; Department of Ophthalmology, Siriraj Hospital, Faculty of Medicine, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok 10700, Thailand (Tel.: (662)411-2006; Fax: (662)411-1906; E-mail: sippb@mahidol.ac.th)

Objective: To evaluate the efficacy of preserved human amniotic membrane transplantation for reconstruction of the corneal surface diseases.Methods: Preserved human amniotic membrane transplantations were performed in 84 eyes of 78 patients for corneal surface reconstruction. The indications were limbal stem cell deficiency from Steven-Johnson syndrome, chemical burn and herpes keratitis (27 eyes), bullous keratopathy (26 eyes), persistent epithelial defect and dellen (17 eyes), band keratopathy (11 eyes), preparing for prosthesis (1 eye), corneal ulcer (1 eye) and acute chemical burn (1 eye).Results: Success was noted in 83.3% (70/84) eyes, partial success in 13.1% (11/84) eyes, and failure in 3.6% (3/84) eyes for an average follow-up of 10.5 months (3 - 29 months). No patient developed major immediate post-operative complications.Conclusion: Amniotic membrane transplantation can reduce inflammation, promote corneal epithelial healing, and decrease irritation in corneal surface problems.

PMID: 15256948 [PubMed - as supplied by publisher]

Application of sterilised human amnion for reconstruction of the ocular surface.

• von Versen-Hoynck F,
• Hesselbarth U,
• Moller DE.

Department of Obstetrics and Gynaecology, Faculty of Medicine, University Hospital of Aachen University, Pauwelsstrasse 30, Aachen, 52074, Germany. fvonversen@ukaachen.de

BACKGROUND: Despite improved surgical techniques and the use of new medication, healing of corneal and conjunctival defects cannot always be achieved. In this connection the clinical use of human amnion, produced by different techniques, has represented a successful alternative for the past ten years. The purpose of the present investigation was the development of a clinically secure, therapeutically efficient, and easy-to-handle (transport, storage, application) allogenic amnion transplant. PATIENTS AND METHODS: A new method for an amnion preparation, which contains a sterilisation process in peracetic acid and a drying process in a laminar flow cabinet, was developed as an alternative to previous techniques described in the literature. Amnion transplantation was used to treat 41 patients, 36 of them with corneal ulcer. Further indications for amnion transplantation were symblepharon, descemetocele, as well as dehiscence of conjunctiva after cerclage. RESULTS: Seventy-three percent of cases showed postoperative improvement evidenced by constant vision, while 15 percent showed decreased vision. CONCLUSIONS: The study confirms the observations of previous investigators who consider amnion transplantation an efficient therapeutic method for a multitude of eye diseases. The new method described in this report, guarantees patients' safety by using a validated new sterilisation process against infections that can be transmitted by human tissue. At present this method constitutes the only process available in Germany, and is approved by the Federal Institute for Drugs and Medical Products (BfArM) for the manufacture of human amnion transplants as a finished medical product.

PMID: 15256840 [PubMed - indexed for MEDLINE]

Amniotic membrane transplantation for reconstruction of corneal ulcer in graves ophthalmopathy.

• Heinz C,
• Eckstein A,
• Steuhl KP,
• Meller D.

Department of Ophthalmology, University of Essen, Hufelandstr. 55, 45122 Essen, Germany. Carsten.Heinz@gmx.net

OBJECTIVE: To report one case of corneal ulceration associated with a severe manifestation of Graves ophthalmopathy that was treated with amniotic membrane (AM) transplantation using the inlay and overlay technique. METHODS: Case report. RESULTS: A 40-year-old woman with Graves ophthalmopathy had a corneal ulcer on the left eye refractory to topical treatment and orbital decompression surgery. Severe Graves ophthalmopathy was characterized by tear film instability, lagophthalmus, and reduced Bell phenomenon. After amniotic membrane transplantation the epithelial and stromal defect healed quickly with improvement of visual acuity and within the dissolution period of the overlay AM. CONCLUSION: Amniotic membrane transplantation is a successful and alternative approach to treat severe corneal surface disorders refractory to medical treatment in patients with Graves ophthalmopathy. Besides having an anti-inflammatory action mechanism, the overlay AM used herein as a temporary patch was possibly functioning as a protective shield to ensure epithelialization of the AM used as a graft in the ulcer bed.

PMID: 15220741 [PubMed - indexed for MEDLINE]

[A clinical study of amniotic membrane transplantation for severe eye burns at the acute stage]

• Zhou SY,
• Chen JQ,
• Liu ZG,
• Huang T,
• Chen LS.

Department of Cornea and External Eye Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China.

OBJECTIVE: To investigate the possibility of ocular surface reconstruction with amniotic membrane in the acute stage of burn injury, to compare the results using fresh and preserved amniotic membranes and to evaluate the surgical methods and their effects. METHODS: Consecutive patients of whole corneal burn above degree III with complete destruction of the limbus were divided into two groups to receive amniotic membrane transplantation (8 eyes of 8 patients with fresh amnion, 12 eyes of 11 patients with preserved one) or lamellar keratoplasty (24 eyes of 22 patients). The follow-up period was 12 to 26 months with an average of (15 +/- 2) months. RESULTS: The ocular surface became stabilized after the transplantation of amniotic membrane. In eyes treated with fresh amniotic membrane, the corneal surface was epithelized immediately. In eyes treated with preserved amniotic membrane, the corneal surface was epithelized only after 2 - 3 weeks. Lamellar keratoplasty was performed in 3 of 12 eyes with preserved amnion transplantation because the amnion was dissolved due to persistent epithelial defects. Amnions were absorbed with time and superficial neovascularization followed in the corneal surfaces. Seven of eight transplanted fresh amnions were absorbed within 2 to 8 months [mean time (4.3 +/- 0.8) months], and 10 of 12 preserved amnions were absorbed within 1 to 3 months [mean time (2.0 +/- 0.3) months]. The difference was statistically significant (t = 4.22, P < 0.01). The conjunctival surface was successfully reconstructed with amniotic membrane at the acute stage of burn injury. Moderate symblepharon occurred in one case only. Corneal dissolution never occurred in all patients who received lamellar keratoplasty, but recurrent erosion of corneal epithelium occurred in the grafts and corneal neovasularization developed eventually. Corneal graft had to be performed again on four eyes and symblapharonplasty had to be performed on seven eyes. Mild to medium symblepharon was observed in 5 of 24 eyes received lamellar keratoplasty. Visual acuity could be maintained at hand movement in eyes treated with amniotic membrane transplantation without secondary glaucoma and cataract. Visual acuity was figure counting in most cases with lamellar keratoplasty. CONCLUSIONS: Amniotic membrane transplantation (especially using a fresh membrane) can effectively reduce the inflammation of the cornea at the acute stage of burn injury, can prevent corneal ulcer and perforation and can make the stabilization process faster. It can also decrease corneal neovascularization as well as establish better conditions for successful keratoplasty.

PMID: 15059561 [PubMed - indexed for MEDLINE]

Relapsing Mooren's ulcer after amniotic membrane transplantation combined with conjunctival autografting.

• Chen KH,
• Hsu WM,
• Liang CK.

Department of Ophthalmology, Taipei Veterans General Hospital, 201 Shih-Pai Road, Section II, Taipei, Taiwan 11217, R.O.C. khchen@vghtpe.gov.tw

PURPOSE: To report a patient with Mooren's ulcer that relapsed 2 months after amniotic membrane (AM) transplantation and conjunctival autografting and its subsequent retreatment. DESIGN: Interventional case report. METHODS: We performed multilayered AM transplantation and conjunctival autografting from the opposite healthy eye to treat a corneoscleral perforation caused by Mooren's ulcer in a 60-year-old woman. MAIN OUTCOME MEASURES: Reformation of the anterior chamber, absence of inflammation, and restoration of visual acuity. RESULTS: The perforated corneoscleral lesion was sealed successfully by the AM and conjunctiva graft and led to a stable condition for 2 months. Relapsing corneal edema, keratic precipitates, and cell infiltration occurred along the margin of the conjunctival graft with severe vessel engorgement. After removing the conjunctival graft and regrafting of additional AM, the lesion subsided for at least 1 year. CONCLUSIONS: Amniotic membrane transplants may be useful in treating corneal perforation of immunologic origin, but conjunctiva and its vessels may play a role in the process of peripheral corneal destruction of Mooren's ulcer.

PMID: 15051214 [PubMed - indexed for MEDLINE]

[Corneal wound healing. II. Treatment of disorders of wound healing]

• Rieck PW,
• Pleyer U.

Augenklinik Charite, Universitatsmedizin Berlin, Campus Wirchow Klinikum, Berlin.

PMID: 15046125 [PubMed - indexed for MEDLINE]

[Amniotic membrane transplantation improves experimental herpetic keratitis. Modulation of matrix metalloproteinase-9]

• Heiligenhaus A,
• Li H,
• Yang Y,
• Wasmuth S,
• Bauer D,
• Steuhl KP.

Augenabteilung am St. Franziskus Hospital, Ophtha-Lab, Munster. arnd.heiligenhaus@t-online.de

PURPOSE: Transplantation of human amniotic membrane (AMT) accelerates the healing of experimental ulcerative herpetic keratitis. Here the expression and activity of matrix metalloproteinase (MMP)-9 was studied. METHODS: BALB/c mice were corneally infected with HSV-1. Whereas the infected corneas of mice in group 1 were covered with AM, tarsorrhaphies were performed in others (group 2). After 2 days, the appearance of corneal ulcers and stromal inflammation was judged clinically, and the corneal PMN infiltration was studied histologically. The expression of MMP-9 in the corneas was localized by immunohistochemistry and analyzed by Western-blot technique. The MMP-9 activity in the corneas was determined by zymography. RESULTS: On day 14, the ulcerating corneas had a dense PMN infiltration, the ulcers and the majority of PMNs were highly positive for MMP-9, and the active forms of MMP-9 were detected. Gelatinolytic activity was found in these corneas by zymography. Compared with the mice of group 2, ulceration, stromal inflammation and neovascularization markedly improved clinically and histologically within 2 days in mice of group 1. This was associated with a reduced expression of MMP-9 in corneal tissue and in PMNs. The gelatinolytic activity of MMP-9 was reduced after AMT. CONCLUSIONS: These observations suggest that improvement of herpetic corneal ulcers and reduced corneal neovascularization after AMT may result from a reduced expression and activity of MMP-9.

PMID: 14872270 [PubMed - indexed for MEDLINE]

[Frequency of reoperations after amniotic membrane transplantation]

• Denk OP,
• Birk U,
• Von Eicken J,
• Knorr M.

Abteilung I, Erkrankungen des vorderen und hinteren Augenabschnittes, Universitatsaugenklinik Tubingen. podenk@med.uni-tuebingen.de

BACKGROUND: Retrospective evaluation of the frequency of reoperations after amniotic membrane transplantation for different pathologic entities. MATERIAL AND METHODS: We included 81 cases of amniotic membrane transplantation (AMT), which were operated on at the university eye clinic Tubingen since 1997 and which had been followed up for at least 12 months. Patient diagnoses were subdivided as follows: conjunctival defects after tumour excision (N = 2), bullous keratopathy (N = 5), external fistula after glaucoma filtering surgery (N = 3), recurrent pterygium (N = 5), symblepharon (N = 6), corneal ulcer with descemetocele (N = 3), non-perforated corneal ulcer (N = 51), perforated corneal ulcer (N = 1), other (n = 5). RESULTS: The overall reoperation rate was determined to be 42 % after a follow-up period of one year. Most frequently, a second AMT (N = 16) and a perforating keratoplasty (N = 16) were performed after the initial AMT. The following reoperation rates were determined for the subgroups: Conjunctival defects after tumour excision (0 %), Bullous keratopathy (60 %), External fistula after glaucoma filtering surgery (67 %), Recurrent pterygium (60 %), Symblepharon (67 %), Corneal ulcer with descemetocele (67 %), Non-perforated corneal ulcer (49 %), Perforated corneal ulcer (100 %). CONCLUSIONS: Particularly in patients with conjunctival defects after tumour excision and with non-perforated corneal ulcers, stabilisation of the ocular surface homeostasis can be achieved with a single amniotic membrane transplantation for at least one year.

PMID: 14745675 [PubMed - indexed for MEDLINE]

[Place of the transplantation of the amniotic membrane in the treatment of corneal diseases concomitant with corneal neovascularization]

• Novitskii IIa.

Published data and authors' independent observations related with the influence produced by the transplantation of the amniotic sac on corneal neovascularization are described. The epithelial-and-stromal corneal defect as well as the limbic epithelium deficit with a subsequent conjunctivization of the corneal epithelium and corneal neovascularization are one of the key mechanisms of corneal neovascularization. The amniotic sac transplantation, made for the purpose of reconstructing the eye surface, ensures the conditions for a fast recovery of the corneal epithelium and, thus, prevent the corneal neovascularization. The surgery can be recommended as an effective treatment technique applicable to corneal pathologies concomitant with the limbic epithelium deficit, persistent epithelial-and-stromal corneal defect and with the corneal neovascularization.

PMID: 14708164 [PubMed - indexed for MEDLINE]

Management of acute ulcerative and necrotising herpes simplex and zoster keratitis with amniotic membrane transplantation.

• Heiligenhaus A,
• Li H,
• Hernandez Galindo EE,
• Koch JM,
• Steuhl KP,
• Meller D.

Department of Ophthalmology, St Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany. arnd.heiligenhaus@t-online.de

AIM: To report promoted healing of acute ulcerative and necrotising herpetic keratitis after amniotic membrane transplantation (AMT). METHODS: Retrospective, non-comparative case series of seven patients with acute ulcerative and necrotising herpetic stromal keratitis. Single or multilayer AMT with epithelial side facing up was performed. The main outcome measures were wound healing of the corneal ulcers and decrease of stromal inflammation. RESULTS: The mean follow up was 10.7 (SEM 1.4) months (range 5-15 months). AMT was performed once in five cases, and twice in further two. Improvement of stromal inflammation was noted within 16.4 (2.5) days (range 7-28 days). Epithelial defects healed within a mean of 17 (2.7) days (range 7-28 days). Vision improved in all but two patients. No serious side effects occurred during the follow up. CONCLUSIONS: Although performed in an uncontrolled and non-randomised series of patients, these findings indicate that the AMT shows promise in selected cases for the restoration of ocular surface integrity, reduction of stromal inflammation, and improvement of vision in acute ulcerative and necrotising herpetic keratitis.

PMID: 14507749 [PubMed - indexed for MEDLINE]

Fresh amniotic membrane transplantation combined lamellar keratoplasty for patients with recurrent Mooren's ulcer.

• Zhou S,
• Chen J,
• Fung B,
• Chen L.

Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China.

PURPOSE: To investigate the possibility of amniotic membrane as an immunological insulating band to reduce the recurrent frequency of Mooren's ulcer. METHODS: Twelve cases(12 eyes) with recurrent Mooren's Ulcer were observed. Among them, 4 cases (4 eyes) were male and 8 cases(8 eyes) female, ranging in age between 26 and 51 years [mean(41 +/- 3) years]. Three eyes recurred once, 5 eyes twice, and 4 eyes three before. Eleven of 12 cases (11/12 eyes) with frequently recurrent Mooren's ulcer underwent lamellar keratoplasty combined amniotic membrane transplantation (AMT). One patient who had entire corneal ulceration accepted AMT alone. RESULTS: Follow-up time is 12 to 29 months, [mean (23 +/- 6) months]. Before AMT, the recurrent frequency of Mooren's Ulcer of all cases after corneal surgery was 1-7 months [mean (3 +/- 2) months]. Nine of 12 eyes with lamellar keratoplasty combined AMT did not recur within the observation period; 2 eyes recurred 11 months after the surgery. Three months postoperatively, neovascularization was observed, which made it nearly impossible to decipher between amniotic membrane and its nearby conjunctiva, only at the junction of the transplant can some trails be observed. One case with entire AMT alone showed graft resolution and neovascularization in 1 month. CONCLUSION: AMT combined with lamellar keratoplasty and lesion excision may delay recurrence of Mooren's Ulcer, reduce its recurrent frequency. Besides the effects of decreasing inflammation, it may have immunological insulating function as well. This conclusion should be proven by further clinical comparative study of much more samples.

PMID: 12852079 [PubMed - indexed for MEDLINE]

[Recurrent corneal ulcer in a patient with Crohn's disease associated with epidermolysis bullosa acquisita]

• Spraul CW,
• Buchwald HJ,
• Lang GK,
• Lang GE.

Universitats-Augenklinik Ulm. christoph.spraul@medizin.uni-ulm.de

BACKGROUND: Crohn's disease is a chronic inflammatory bowel disease, leading to ocular manifestations in 4 - 8 % of patients. We report on a patient with Crohn's disease, who developed in association with epidermolysis bullosa acquisita a progressive corneal ulcer. PATIENT: A 26-year old patient with a 3-year history of Crohn's disease presented with a peripheral corneal ulcer of the right eye. The anterior chamber was deep and quiet. Fundus examination was normal. Corneal smears displayed no bacterial growth. Visual acuity of the right eye was 20/25. Examination of the left eye was normal. Furthermore, he had developed cutaneous blisters on the arms and legs. Despite treatment with topical antibiotics and systemic immunosuppressive therapy with tacrolimus, azathioprine and methylprednisolone the corneal manifestation deteriorated. Therefore, an amniotic membrane was transplanted for treatment of the corneal ulcer; however, this was followed by melting of the amniotic membrane within a few days. Additional therapeutic procedures including further amniotic membrane transplantations and autologous conjunctival grafts have been performed. This was regularly unsuccessful. The corneal ulcer increased in size and extended into the sclera. Therefore a tectonic sclerokeratoplasty was necessary. Histologic examination of the excised corneoscleral tissue revealed an extensive stromal thinning associated with inflammatory infiltration of the cornea and sclera. CONCLUSIONS: Corneal complications in patients with Crohn's disease are very rare in contrast to conjunctivitis, episcleritis und uveitis. To the best of our knowledge, this is the first description of a patient with Crohn's disease and epidermolysis bullosa acquisita developing progressive corneal ulcer. How closely an assumed autoimmune mechanism in the cornea is related to Crohn's disease or epidermolysis bullosa acquisita, is not known.

PMID: 12830398 [PubMed - indexed for MEDLINE]

[Fresh amniotic membrane transplantation for ocular surface diseases]

• Luo HY,
• Peng SM,
• Wang YJ.

Department of Ophthalmology, Second People's Hospital of Fuling District, Chongqing 408000, China.

OBJECTIVE: To evaluate the therapeutic effects of fresh amniotic membrane transplantation for ocular surface disorders (OSDs). METHODS: Fresh amniotic membrane transplantation was performed in 38 cases (52 eyes) of ocular surface diseases, including pterygium, recurrent pterygium, Mooren's ulcer, Viral keratitis, and symblepharon. Follow-up studies ranging from 3 to 12 months were conducted. RESULTS: No acute graft rejection was observed following the operation in these cases, and no recurrence was found in cases of pterygium and corneal ulcer during the follow-up period. The ocular movement was restored for the eyes with severe symblepharon. CONCLUSION: Fresh amniotic membrane can be used as a graft material for ocular surface reconstruction, in which complete removal of the pathological tissues and reliable fixation of the amniotic membrane graft are crucial steps.

PMID: 12754140 [PubMed - indexed for MEDLINE]

Amniotic membrane transplantation for corneal perforation related to vitamin A deficiency.

• Su WY,
• Chang SW,
• Huang SF.

Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China.

Corneal perforation is one of the most vision-threatening consequences of vitamin A deficiency. Amniotic membrane transplantation was performed in a 36-year-old man who presented with bilateral corneal ulcers. There was a small, sharply demarcated superficial ulcer with crevices of surrounding keratinized epithelium converging on the ulcer and minimal infiltration at the inferior periphery of the right cornea. A 3-mm perforation on a 9 x 7-mm area of stromal melting was noticed in the left cornea. The serum vitamin A level was 14.0 microg/dL (normal, 24.57 to 105.71 microg/dL) at presentation. A biopsy of the right corneal epithelium was performed to confirm the diagnosis. Multilayered amniotic membrane transplantation with debridement of the necrotic corneal stroma was performed on the left cornea. In addition to systemic vitamin A replacement, topical antibiotics and lubricants were also administered. The cornea ulcers healed in 10 days along with the restoration of the serum vitamin A level. The visual acuity improved from 20/250 to 20/20 in the right eye and from light perception to hand movement in the left eye at 3 months. Amniotic membrane transplantation could save eyes with corneal perforation related to vitamin A deficiency before reconstructive surgeries, such as penetrating keratoplasty, are necessary.

PMID: 12665231 [PubMed - indexed for MEDLINE]

Corneal sensitivity and ocular surface changes following preserved amniotic membrane transplantation for nonhealing corneal ulcers.

• Dogru M,
• Yildiz M,
• Baykara M,
• Ozcetin H,
• Erturk H.

Department of Ophthamology, Faculty of Medicine, Uludag University, Bursa, Turkey. muratodooru@yahoo.com

PMID: 12640399 [PubMed - indexed for MEDLINE]

[Gore-tex(r) patch in immunologically conditioned corneal ulcer]

• Amm M,
• Nolle B.

Klinik fur Ophthalmologie der Christian-Albrechts-Universitat Kiel, Germany. mamm@ophthalmol.uni-kiel.de

BACKGROUND: The treatment of immunological corneal disease and melting is still a challenge for any ophthalmologist. Adequate systemic treatment as well as the surgical intervention with an allogeneic corneal graft needs time. In case of emergency a gore-tex(R) patch is an alternative option. PATIENTS AND METHOD: We report on the pre- and postoperative courses of six eyes suffering from rheumatic corneal ulcer resp. immune mediated descemetocele treated by a gore-tex(R) patch. Follow-up ranged between 6 to 30 months. RESULTS: In all cases corneal perforation could be prevented, the artificial graft kept the anterior chamber tight. No infection or graft extrusion developed. DISCUSSION: Different surgical methods are optional in the treatment of rheumatic and immunologic corneal diseases (lamellar or penetrating keratoplasty a chaud, conjunctival flap, amniotic membrane transplantation, contact lenses with adhesive). Another possibility, the gore-tex(R) patch, is an easily available and easy-to-handle tissue, which allows stabilisation of the situation and saves time.

PMID: 12447718 [PubMed - indexed for MEDLINE]

Amniotic membrane transplantation for ocular surface reconstruction in neurotrophic corneal ulcera.

• Ivekovic B,
• Tedeschi-Reiner E,
• Petric I,
• Novak-Laus K,
• Bradic-Hammoud M.

Department of Ophthalmology, University Hospital Sestre Milosrdnice, Zagreb, Croatia.

The purpose of this study is to analyze clinical experience about the effects of human amniotic membrane transplantation in eyes with neurotrophic ulcers. In 11 eyes the application of amniotic membrane was performed since January 1999 because of neurotrophic ulcers. The follow up period was longer than 12 months: 19.7+/-6.0 months. The average healing period after the surgery was 1.6+/-0.6 weeks. All corneas were fluorescein negative even 12 months after operation. Visual acuity after the transplantation was similar to the one before the surgery in 8 eyes. In 3 eyes the visual acuity after the surgery was better than before. Amniotic membrane transplantation can be considered an effective alternative for treating persistent epithelial defects such as neurotrophic ulcers. It has some advantages over corneal transplantation: a relatively simple procedure, no allograft rejection and it could be particularly beneficial in countries where cornea shortage is apparent.

PMID: 12137322 [PubMed - indexed for MEDLINE]

Amniotic membrane grafts for nontraumatic corneal perforations, descemetoceles, and deep ulcers.

• Solomon A,
• Meller D,
• Prabhasawat P,
• John T,
• Espana EM,
• Steuhl KP,
• Tseng SC.

Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA.

PURPOSE: To describe the clinical outcome of amniotic membrane transplantation (AMT) for nontraumatic corneal perforations, descemetoceles, and deep ulcers. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Thirty-four eyes of 33 consecutive patients operated on for nontraumatic corneal perforations or descemetoceles at four academic departments of ophthalmology. Associated autoimmune disorders included rheumatoid arthritis (n = 6), Stevens-Johnson syndrome (n = 3), ocular cicatricial pemphigoid (n = 2), systemic lupus erythematosus (n = 1), and one eye with Mooren's ulcer, as well as neurotrophic, or exposure keratopathy (n = 10), postinfectious nonhealing ulcers (n = 6), and postsurgery (n = 5). INTERVENTION: Three or four layers of amniotic membrane (AM) were applied over the ulcer bed and anchored with 10-0 nylon interrupted or running sutures. A large AM piece was used as a patch to cover the entire corneal surface. MAIN OUTCOME MEASURES: Formation of anterior chamber depth, epithelialization of the AM grafts, and stability of the corneal stromal thickness. RESULTS: The mean follow-up period was 8.1 +/- 5.7 (ranging from 2-23) months. A successful result was observed in 28 of 34 eyes (82.3%). Of the successful cases, 23 eyes needed one AMT procedure, whereas 5 eyes needed two procedures to achieve a successful result. In five eyes, a subsequent definitive surgical procedure such as penetrating keratoplasty or lid surgery was needed. Failure was observed in six eyes with rheumatoid arthritis, neurotrophic keratopathy, or graft melting. CONCLUSIONS: AMT is an effective method for managing nontraumatic corneal perforations and descemetoceles. It can serve as either a permanent therapy or as a temporizing measure until the inflammation has subsided and a definitive reconstructive procedure can be performed. This treatment option is also beneficial in those countries where corneal tissue availability is limited.

PMID: 11927426 [PubMed - indexed for MEDLINE]

Amniotic membrane graft for the management of scleral melting and corneal perforation in recalcitrant infectious scleral and corneoscleral ulcers.

• Ma DH,
• Wang SF,
• Su WY,
• Tsai RJ.

Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

PURPOSE: To study the efficacy and safety of using cryopreserved human amniotic membrane (AM) graft as a patch graft to reduce stromal melting and promote reepithelialization in extensive infectious scleral and corneoscleral ulcers. METHODS: Four cases of infectious scleral ulcers with persistent scleral melting and no sign of reepithelialization and three cases of corneoscleral ulcers with corneal perforation were studied. All patients had previously undergone pterygium excision, and infections were caused by Pseudomonas (n = 4), fungi (n = 2), and atypical Mycobacterium (n = 1). The area of limbus involved ranged from 3 to 9 (mean, 4.7) o'clock positions. Repeated debridements were performed, the causative microorganisms were identified, and the appropriate topical and systemic antibiotics were given to all patients before AM grafting. Postoperatively, the speed of reepithelialization, changes in the severity of scleral melting and inflammation, recurrence of infection, and visual acuity were documented. RESULTS: Melting and inflammation at the lesion site decreased after AM grafting. Reepithelialization of the scleral lesions was complete at an average 15.7 +/- 8.7 days (range, 5-31) postoperatively. Focal melting of the AM graft occurred in two cases, and in one case, it was necessary to perform further corneoscleral graft. No recurrent infection was encountered, but sterile abscess occurred in three cases that were located away from the original lesion. Useful vision above 20/400 was maintained in all patients at the end of follow-up. CONCLUSION: The AM graft is effective in promoting conjunctival reepithelialization and reducing scleral melting and inflammation and can be considered as an alternative biomaterial to improve wound healing in scleral and corneoscleral ulcerations.

PMID: 11917176 [PubMed - indexed for MEDLINE]

Histologic findings after amniotic membrane graft in the human cornea.

• Gris O,
• Wolley-Dod C,
• Guell JL,
• Tresserra F,
• Lerma E,
• Corcostegui B,
• Adan A.

Instituto de Microcirugia Ocular (IMO), Universitat Autonoma de Barcelona, Munner 10, 08022 Barcelona, Spain.

OBJECTIVE: To describe the histopathologic findings in the human cornea several months after a stromal amniotic membrane graft. To show the clinicopathologic correlation after the graft in two cases with different follow-up times. DESIGN: Two interventional case reports with clinicopathologic correlation. PARTICIPANTS: Two patients with neurotrophic corneal ulcer unresponsive to medical treatment (one with stromal vascularization and the other without stromal vascularization). INTERVENTION: Amniotic membrane graft was performed in both patients to treat the neurotrophic ulcer. Three and 7 months after amniotic membrane grafting, a penetrating keratoplasty was needed, and the removed corneas were analyzed. MAIN OUTCOME MEASURES: Clinical and histopathologic examinations, including routine histopathologic and immunohistochemical studies. RESULTS: Complete epithelialization was observed on histologic examination over the basement membrane of the amniotic membrane graft. The amniotic membrane was slowly reabsorbed in the cornea without stromal vascularization with no inflammatory reaction produced. In the cornea that had stromal vascularization the amniotic membrane was rapidly reabsorbed because of the presence of abundant inflammatory cells. Once reabsorbed, the amniotic membrane was replaced by new fibrotic stroma, that was different from that found in the rest of the cornea but that helped to maintain corneal thickness. CONCLUSIONS: The amniotic membrane graft allows for correct epithelialization in cases of neurotrophic corneal ulcer. Once the amniotic membrane is reabsorbed, it is replaced by a new fibrotic stroma, which can reduce corneal transparency. In corneas that have no stromal vascularization, the graft may remain in the stroma for many months, compromising corneal transparency during this period.

PMID: 11874752 [PubMed - indexed for MEDLINE]

[Treatment of corneal ulcerations with use of the amniotic membrane]

• Gierek-Lapinska A,
• Mrukwa-Kominek E,
• Rokita-Wala I,
• Gierek-Ciaciura S.

I Katedry i Kliniki Okulistyki Slaskiej AM w Katowicach.

Corneal ulcerations may cause complications such as, for example, the loss of transparency, descemetocele or perforation of the cornea. Widely used therapies do not always bring expected results. Recently the amniotic membrane has been applied for the treatment of corneal ulceration. PURPOSE: The purpose of the present study was to evaluate the efficacy of the amniotic membrane suturing over the locations of corneal ulcers. MATERIAL AND METHODS: The amniotic membrane was sutured over the locations of corneal ulcers in 9 eyes of 9 patients suffering from ulcers which did not regress with traditional therapeutic methods. After meticulous debridement of the ulcer floor and border area the amniotic membrane was sutured to the cornea with a single 10.0 Nylon suture (around the ulcer area), and additionally suture were fixed to the sclera. Following the procedure contact lenses were placed over the area for protection. The observation period was 6 months. Follow-up examinations were performed regularly during the first seven postoperative days, then after 2, 4 and 12 weeks; the final follow-up took place 6 months after the procedure. RESULTS: In all patients we observed healing of the corneal defect, improvement of visual acuity and regression of the active inflammatory process. After this procedure the subjective symptoms subsided. CONCLUSION: The amniotic membrane can be used for the treatment of corneal ulceration of various etiology.

PMID: 11873419 [PubMed - indexed for MEDLINE]

[A clinical study on fresh amniotic membrane transplantation for treatment of severe ocular surface disorders at acute inflammatory and cicatricial stage]

• Chen J,
• Zhou S,
• Huang T,
• Liu Z,
• Chen L,
• Lin Y.

Zhongshan Ophthalmic Center, Sun Yat-sen University of Medical Sciences, Guangzhou 510060, China.

OBJECTIVE: To investigate the safety and evaluate the effect of fresh amniotic membrane transplantation to reconstruct the ocular surface with severe inflammation and scarring. METHOD: Amniotic membrane transplantation (38 cases, 46 eyes), or combined with either limbal transplantation (9 cases, 9 eyes) or lamellar keratoplasty (8 cases, 8 eyes) was performed on ocular surface burns (5 cases, 6 eyes), recurrent Mooren's ulcer (8 cases, 8 eyes) and severe symblepharon (38 cases, 46 eyes). All the patients were followed-up for 6 - 18 months (mean, 11 months). Impression cytology was examined in 21 eyes with normal tear secretion post-operatively. RESULTS: No acute rejection was observed after fresh amniotic membrane transplantation. No progressive melt and perforation were seen in five out of six eyes with burns in reconstructed ocular surfaces. Neovascularization, pseudopterygium and iris atrophy were not found during the follow-up. Visual acuity was improved in various degrees. Corneal ulceration was not noted in 8 cases (8 eyes) with frequently recurrent Mooren's ulcer. Ocular surface reconstruction was successful in 46 of 49 eyes with severe symblepharon. Symblepharon occurred in the remaining three eyes but much less than pre-transplantation in degree. Amniotic epithelia have been examined in about three months on the transplanted eyes with normal tear secretion. CONCLUSION: Fresh amniotic membrane can be used as a graft to reconstruct ocular surface. Such transplantation can effectively reduce neovascularization, fibrosis and inflammation. Our data indicated that complete removal of pathological tissues and perfect fixation of amniotic membrane graft are crucial steps in the reconstruction of ocular surface.

PMID: 11853574 [PubMed - indexed for MEDLINE]

Multilayer vs. monolayer amniotic membrane transplantation for deep corneal ulcer treatment.

• Dekaris I,
• Gabric N,
• Mravicic I,
• Karaman Z,
• Katusic J,
• Lazic R,
• Spoljaric N.

Lions Croatian Eye Bank, Department of Ophthalmology, General Hospital Sveti Duh, Zagreb, Croatia.

The purpose of the study was to evaluate the efficacy of multilayer amniotic transplantation (AMT) for reconstruction of corneal stroma and epithelium. Corneal ulcer (28) was a consequence of a previous infectious or neurotrophic keratitis. In the first group (17) ulcer was covered with monolayer AM, while in the other group (11) there were two or more layers of AM situated in the ulcer and the whole cornea was covered with AM sheet. Monolayer AMT was successful in 64% while the multilayer AMT success rate was 72%. AM gradually dissolved within 3-6 postoperative weeks. AM transplantation facilitates rapid healing of corneal epithelium, reduces inflammation and stimulates epithelial cell regrowth. In eyes with deep corneal ulcer multilayer technique proved to be better then monolayer procedure.

PMID: 11817009 [PubMed - indexed for MEDLINE]

Comment on:

Br J Ophthalmol. 2001 Dec;85(12):1455-63.

Amniotic membrane transplantation for persistent corneal epithelial defect.

• Tseng SC.

PMID: 11734507 [PubMed - indexed for MEDLINE]

[Should indications for amniotic membrane transplantation be altered in concurrent rheumatoid polyarthritis?]

• Gabler B,
• Winkler von Mohrenfels C,
• Lohmann CP.

Augenklinik der Universitat Regensburg, Franz-Josef-Strauss-Allee, 93042 Regensburg. Bernhard.Gabler@klinik.uni-regensburg.de

BACKGROUND: Amniotic membrane transplantation (AMT) shows good results in corneal epithelial defects or ulcerations. However, in patients with rheumatoid arthritis (RA) these corneal defects represent a somewhat greater challenge. We address the question whether AMT has to be indicated differently in RA patients. PATIENTS AND METHODS: We retrospectively analysed 25 AMTs performed between October 1998 and August 2000 in 22 patients for corneal epithelial defects and ulcerations. In 8 patients (11 AMTs) RA was present (group A) and no RA (group B) was found in 14 patients (14 AMTs). RESULTS: Epithelial closure could be achieved in 24/25 cases after a mean of 24.9 days. In 15/25 cases the epithelium remained closed over a minimum of 3 months (successful AMT). In group B, 12/14 AMTs (85.7%) were successful, but only 3/11 AMTs (27.3%) were successful in group A. DISCUSSION: In addition to the pronounced keratoconjunctivitis sicca, immune-mediated inflammatory aspects are suspected to be the reason for the poor results of AMT in RA patients. But as alternative surgical procedures (e.g. keratoplasty) implicate specific problems in RA, we believe that after failure of conservative treatment AMT is a reasonable procedure for corneal defects even in RA patients.

PMID: 11594227 [PubMed - indexed for MEDLINE]

Amniotic membrane transplantation in infectious corneal ulcer.

• Kim JS,
• Kim JC,
• Hahn TW,
• Park WC.

Department of Ophthalmology, Chung-Ang University Hospital, Hangang-Ro 3ka 65-207, Yongsan-ku 140-757, Seoul, Korea.

PURPOSE: To evaluate the efficacy of amniotic membrane transplantation in the management of treated infectious corneal ulcer in which inflammatory reactions were responsible for corneal damage. METHOD: A prospective study of 21 consecutive eyes (21 patients) was performed. Sufficient antibacterial, antifungal, or antiviral agents were applied to eradicate causative organisms before permanent or temporary amniotic membrane transplantation, or a combination of the two in few patients. The amniotic membrane was soaked in antiinfective agents before transplantation in all cases. RESULTS: After amniotic membrane transplantation, follow-up times ranged from 4 to 28 months (mean, 18 months). Clinical indications included Staphylococcus species (four cases), Pseudomonas species (five cases), Acanthamoeba species (three cases), fungus (two cases), and herpesvirus (seven cases). The corneal surface was healed successfully and recurrences of microbial infection were not noted in any case. Visual acuity was improved in cases that were nonscarring or after additional penetrating keratoplasty. CONCLUSION: Amniotic membrane transplantation seems to be a useful adjunctive surgical procedure for the management of infectious corneal ulcer by promoting wound healing and reducing inflammation.

PMID: 11588424 [PubMed - indexed for MEDLINE]

[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]

• Ferreira De Souza R,
• Hofmann-Rummelt C,
• Kruse FE,
• Seitz B.

Augenklinik mit Poliklinik der Friedrich-Alexander Universitat Erlangen-Nurnberg, Schwabachanlage 6, 91054 Erlangen, Germany. berthold.seitz@augen.imed.uni-erlangen.de

PURPOSE: 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. PATIENTS AND METHODS: 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 %). RESULTS: 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. CONCLUSION: 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 a chaud or conjunctival flaps. However, in eyes with broad descemetocele especially following chemical burns, this treatment modality does not seem to be effective.

PMID: 11573153 [PubMed - indexed for MEDLINE]

Amniotic membrane transplantation for ocular surface reconstruction.

• Prabhasawat P,
• Kosrirukvongs P,
• Booranapong W,
• Vajaradul Y.

Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

OBJECTIVE: To study the efficacy of amniotic membrane transplantation in various indications for ocular surface reconstruction. METHOD: Amniotic membrane transplantations were performed in 140 eyes (130 patients) for ocular surface reconstruction. The indications for the corneal group were limbal stem cell deficiency, bullous keratopathy, persistent epithelial defect, band keratopathy, prosthesis, corneal ulcer and acute chemical burn. The indications for the conjunctival group were grafts for pterygium, conjunctival tumors, symblepharon, and covering the scleral graft. RESULTS: Success was noted in 75.7 per cent (106/140) eyes, partial success in 17.9 per cent (25/140) eyes, and failure in 6.4 per cent (9/140) eyes for a mean follow-up of 6.6 months (1-19 months). The success and partial success rate were 80.6 per cent (54/67), 14.9 per cent (10/67) in the corneal group and 71.2 per cent (52/73), 20.6 per cent (15/73) in the conjunctival group. CONCLUSION: Amniotic membrane transplantation can solve some difficult ocular surface problems, and can be used to promote epithelial healing, reduce inflammation and scarring.

PMID: 11560222 [PubMed - indexed for MEDLINE]

[Zinsser-Engman-Cole syndrome (dyskeratosis congenita) with severe sicca syndrome, panuveitis and corneal perforation--a case report]

• Zagorski Z,
• Biziorek B,
• Rakowska E,
• Jedrzejewski D.

Universitats-Augenklinik, Chmielna 1, 20-075 Lublin, Polen.

BACKGROUND: Zinsser-Engman-Cole syndrome (Z.E.C.) is a very rare type of ectodermal dysplasia, inherited in X-linked recessive manner and characterised by poikiloderma, nail dystrophy, lingual leucoplakia, bone marrow hypoplasia, hyperkeratosis and hyperhidrosis of planta and palms, dental anomalies and caries, premature grey hair. PATIENT AND METHODS: We report on a 46-year-old man who presented with occlusion of lacrimal puncta, trichiasis, severe dry eye, recurrent corneal ulceration and perforation, uveitis. HLA typing, flow cytometry of peripheral lymphocytes, bone marrow biopsy, conjunctival biopsy and extensive laboratory evaluation towards autoimmune and infectious diseases were performed. RESULTS: CD4+ T cells fraction was decreased, CD8+ and CD3+ HLA DR+ elevated. The patient was HLA-B27 positive. Laboratory studies revealed increased erythrocyte sedimentation rate and C-reactive protein level, hypochromic and hypoplastic anaemia, negative serum titers of antibodies to Epstein-Barr virus, HIV, HTLV-I, toxoplasma gondii and treponema pallidum, repeated titers to cytomegalovirus, herpes simplex and herpes zoster viruses--IgM negative, IgG positive. Corneal perforation was treated with amniotic membrane transplantation and corneal transplantation. CONCLUSION: The defect in cell-mediated immune mechanisms in Z.E.C. syndrome explains the corneal perforation, sicca syndrome and uveitis, first reported in this syndrome.

PMID: 11488014 [PubMed - indexed for MEDLINE]

Amniotic membrane transplantation in the management of shield ulcers of vernal keratoconjunctivitis.

• Sridhar MS,
• Sangwan VS,
• Bansal AK,
• Rao GN.

Cornea Center, L. V. Prasad Eye Institute, Hyderabad, India.

PURPOSE: To report our experience with amniotic membrane transplantation in the management of severe shield ulcers. DESIGN: Retrospective, interventional, noncomparative case series. PARTICIPANTS: Four patients (seven eyes) with grade 2 (ulcer with opaque base) and grade 3 (plaquelike lesions) shield ulcers not responding to steroid therapy with or without surgical debridement. INTERVENTION: Amniotic membrane transplantation with stromal side down was performed after meticulous debridement of the ulcer. MAIN OUTCOME MEASURES: Healing of the ulcer with no epithelial defect. RESULTS: The ulcers healed with disintegration or retraction of the membrane in all patients within 2 weeks. CONCLUSIONS: Amniotic membrane transplantation in combination with debridement is an effective surgical modality in the management of severe shield ulcers. Further studies are warranted to confirm the efficacy of amniotic membrane transplantation in the management of shield ulcer and its correct position in the treatment algorithm.

PMID: 11425678 [PubMed - indexed for MEDLINE]

Amniotic membrane inlay and overlay grafting for corneal epithelial defects and stromal ulcers.

• Letko E,
• Stechschulte SU,
• Kenyon KR,
• Sadeq N,
• Romero TR,
• Samson CM,
• Nguyen QD,
• Harper SL,
• Primack JD,
• Azar DT,
• Gruterich M,
• Dohlman CH,
• Baltatzis S,
• Foster CS.

Immunology Service, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA.

OBJECTIVES: To determine the effect of amniotic membrane transplantation (AMT) on persistent corneal epithelial defects (PEDs) and to compare the efficacy between inlay and overlay techniques. METHODS: Thirty patients (30 eyes) underwent AMT for PED. The use of AMT was restricted to patients in whom all previous measures, including bandage contact lens and tarsorrhaphy, had failed. The amniotic membrane was placed on the surface of the cornea in overlay (group A) or inlay (group B) fashion. RESULTS: The PED healed after the first AMT in 21 eyes (70%) within an average of 25.5 days after surgery and recurred in 6 eyes (29%). Among the 22 eyes treated with an overlay AMT (group A), the PED healed after the first AMT in 14 eyes (64%) within an average of 24.5 days and recurred in 4 eyes (29%). Among the 8 eyes treated with an inlay AMT (group B), the PED healed within an average of 27.4 days after AMT, which did not statistically significantly differ from group A (P = .72). The PED healed after the first AMT in 7 eyes (88%) and recurred in 2 (29%) of 7 eyes. CONCLUSIONS: The AMT can be helpful in the treatment of PED in which all other conventional management has failed. However, the success rate in our study was not as high as that previously reported, and our results showed a high incidence of recurrences of epithelial defects. We did not find any difference between overlay and inlay techniques in terms of healing time and recurrence rate.

PMID: 11346392 [PubMed - indexed for MEDLINE]

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

• Hanada K,
• Shimazaki J,
• Shimmura S,
• Tsubota K.

Department of Ophthalmology, Tokyo Dental College, Chiba, Japan. hanada@asahikawa-med.ac.jp

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.

PMID: 11239864 [PubMed - indexed for MEDLINE]

Human amniotic membrane in the reconstruction of the ocular surface.

• Gabric N,
• Mravicic I,
• Dekaris I,
• Karaman Z,
• Mitrovic S.

Lions Croatian Eye Bank, Department of Ophthalmology, Sveti Duh General Hospital, Zagreb. lhob@yahoo.com

We sought to determine the efficacy of amniotic membrane transplantation (AMT) in the reconstruction of ocular surface. AMT was performed on 40 eyes with following indications: I, persistent corneal ulceration (n = 12); II, impending perforation (n = 6); III, persistent epithelial defect on the corneal graft (n = 6); IV, recurrent pterygia (n = 10), and V, risk of conjunctival scarring (n = 6). Amniotic membrane was prepared from a fresh placenta under sterile conditions, washed with BSS containing penicillin, streptomycin, neomycin and amphotericin B and stored at -80 degrees C in 1:1 InoSol:Glycerol solution. Donor serological test for HIV, HBV and HCV were all negative. Associated surgical procedures according to indication were performed. Healing of the corneal ulcer in Group I was obtained in 67% of eyes at 1-3 weeks after surgery, Group II: AMT was followed by 'a chaud' keratoplasty in 33% and by planned keratoplasty in 67% patients, Group III: healing of the defect in 33% of eyes in 2-5 postoperative weeks, Group IV: no recurrence of pterygium ingrowth in 70% in the follow up period of 6-14 months, and V: 84% of patients had good eye motility without any synechia formation. We concluded that AMT have shown to be effective in enhancing healing of the corneal defects, in prevention of symblepharon formation and recurrent pterygium ingrowth. In case of impending perforation, AMT alone was not a method of treatment but is useful as a first step procedure in preparing the eye for the corneal transplantation.

PMID: 10945447 [PubMed - indexed for MEDLINE]

Amniotic membrane transplantation for severe neurotrophic corneal ulcers.

• Chen HJ,
• Pires RT,
• Tseng SC.

Ocular Surface and Tear Center, Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA.

AIMS: To evaluate whether amniotic membrane transplantation can be an effective alternative treatment for neurotrophic corneal ulcers. METHODS: Amniotic membrane transplantation was performed in 16 eyes of 15 patients with neurotrophic corneal ulcers and vision equal to or worse than 20/200. The neurotrophic state was developed following keratoplasty (four eyes), herpes zoster ophthalmicus (four eyes), diabetes mellitus (four eyes), radiation (two eyes), removal of acoustic neuroma with neuroparalysis (one eye), and herpes simplex keratitis (one eye). RESULTS: During a mean follow up period of 18.8 (SD 13.0) months, one to three layers of amniotic membrane with or without additional membrane as a patch were used for 17 procedures in 16 eyes for persistent neurotrophic corneal ulcers. All but four (76.4%) instances of amniotic membrane transplantation achieved rapid epithelialisation in 16.6 (9.0) days. Of the four eyes showing delayed healing, three eyes healed by tarsorrhaphy, and the remaining one eye with corneal perforation required penetrating keratoplasty and tarsorrhaphy. Two eyes gained vision better than 20/200. The healed corneal surface was accompanied by reduced inflammation. CONCLUSION: Amniotic membrane transplantation can be considered an effective alternative for treating severe neurotrophic corneal ulcers.

PMID: 10906085 [PubMed - indexed for MEDLINE]

Comment in:

Ophthalmology. 2001 Oct;108(10):1714-5.

Hypopyon after repeated transplantation of human amniotic membrane onto the corneal surface.

• Gabler B,
• Lohmann CP.

University Eye Clinic, Regensburg, Germany. bernhard.gabler@klinik.uni-regensburg.de

OBJECTIVE: The authors describe a localized probable immunoreaction after repeated transplantation of amniotic membrane (AM) onto the corneal surface. DESIGN: Interventional case report. INTERVENTION: Amniotic membrane was transplanted onto the corneal surface of a 78-year-old female with a deep trophic corneal ulcer resulting in temporary epithelial closure. A second and finally third amniotic membrane transplantation (AMT) was performed because of recurrent ulcerations. All three AMs were obtained from the same donor. RESULTS: The first transplantation of the AM was without complication. However, a hypopyon developed 2 days after the second and 2 days after the third AMT, but the patient responded immediately to topical and systemic corticosteroids. CONCLUSIONS: Immunologic, toxic, and hypersensitivity effects could have contributed to the hypopyon iritis that appeared after the second and third AMT, but not after the initial transplantation. In case of a repeated AMT, the use of AM from different donors may help to minimize the risk of an immediate postoperative intraocular inflammation.

PMID: 10889109 [PubMed - indexed for MEDLINE]

Application of the amniotic membrane in ocular surface pathology.

• Gris O,
• Guell JL,
• Lopez-Navidad A,
• Caballero F,
• Del Campo Z.

Department of Ophthalmology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

The amnion is a fine semi-transparent membrane that has been used in clinical practice to encourage epithelization in burns, in skin ulcers, or as a skin graft. Application in ocular surface disorders first took place in 1940. We carried out the membrane amniotic implantation on 11 patients with different pathologies: three cases of limbal stem cell deficiency (caustication with failure of prior keratoplasty, congenital aniridia and post-radiotherapy keratopathy), one case with persistent neurotrophic corneal ulcer after prior keratoplasty, four cases with epithelial defect of long evolution, one case of extensive Salzmann's degeneration of the cornea, and two cases after the resection of conjunctival tumour. The follow-up period varied between 2 and 6.5 months (mean = 4 months). Amniotic membrane was obtained by elective Caesarean, and it was preserved at -80 degrees C. In all transplanted patients the reabsorption of the amniotic membrane took place between the third and the fifth week. In the cases of resection of conjunctival tumour the epithelialization was completed between the first and the second post-operative week, with minimal residual scarring. In the other cases, with affliction of the corneal epithelium, the complete epithelialization, together with a marked reduction in the inflammatory response, occurred in all except 2 cases. In conclusion, the implantation of preserved human amniotic membrane can favour the recovery of a normal ocular surface in different pathologies, both in corneal and conjunctival lesions.

PMID: 10853789 [PubMed - indexed for MEDLINE]

[Application of amniotic membrane transplantation in severe corneal diseases]

• Rakowska E,
• Zagorski Z,
• Kardaszewska A,
• Durakiewicz D.

I Klinika Chorob Oczu AM, Lublin.

PURPOSE: To present our experience with the amniotic membrane transplantation in severe corneal diseases. MATERIAL AND METHODS: In 1998 amniotic membrane transplantation was applied in 18 eyes (17 patients) with severe and persistent corneal diseases. The indications were as follows: perforated corneal ulcer--9 eyes, persistent non-perforated corneal ulcer--4 cases, recurrent transplant disease--2 eyes, 1 patient with Sjogren syndrome and 1 with keratolysis in the course of ulcerative colitis. Amniotic membrane was prepared in the International Eye Bank of Lublin from human placenta after elective caesarean section according to the standard protocol. RESULTS: In 7 eyes with perforated ulcers and 4 eyes with non-perforated ulcers prompt healing was observed. In 4 cases markedly improved visual acuity resulted from corneal clarification. In 1 eye perforation persisted in spite of amniotic membrane transplantation and keratoplasty was performed afterwards. In the case of keratolysis, amniotic membrane transplantation did not prevent corneal perforation which was closed successfully with autologous conjunctival flap. In 2 eyes with recurrent transplant disease amniotic membrane dissolved quickly after transplantation. In one case the state of the cornea improved. The second eye required retransplantation of the membrane. We observed that amniotic membrane dissolved more quickly in a vascularized bed. CONCLUSION: Amniotic membrane transplantation may be considered a good alternative method for treating severe corneal disorders that are refractory to conventional treatment.

PMID: 10786047 [PubMed - indexed for MEDLINE]

[Techniques for reconstruction of the corneal surface by transplantation of preserved human amniotic membrane]

• Kruse FE,
• Rohrschneider K,
• Volcker HE.

Universitats-Augenklinik Heidelberg.

Persistent defects of the ocular surface remain a therapeutic challenge, which often requires surgical intervention. Recently, transplantation of human amniotic membrane has been suggested for reconstruction of the corneal surface. We describe two techniques using cryo-preserved amniotic membrane. Transplantation of several layers of amniotic membrane can successfully restore deep corneal ulcers associated with persistent epithelial defects. When such defects are not associated with stromal ulcers, they might benefit from amniotic membrane grafts sutured to cover the entire corneal surface. Both methods may serve as valuable tools for ocular surface reconstruction, especially in the context of impaired epithelial function.

PMID: 10552162 [PubMed - indexed for MEDLINE]

Multilayer amniotic membrane transplantation for reconstruction of deep corneal ulcers.

• Kruse FE,
• Rohrschneider K,
• Volcker HE.

Department of Ophthalmology, University of Heidelberg, Germany. Friedrich_Kruse@ukl.uni-heidelberg.de

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.

PMID: 10442895 [PubMed - indexed for MEDLINE]

[Transplantation of amniotic membrane for reconstruction of the eye surface]

• Kruse FE,
• Rohrschneider K,
• Volcker HE.

Universitats-Augenklinik Heidelberg.

Persistent defects of the ocular surface remain a therapeutic challenge that often requires surgical intervention. Recently, the transplantation of human amniotic membrane has been added to our therapeutic armentarium. This thick basement membrane has distinct biological properties that influence cellular differentiation and proliferation. Amniotic membrane obtained from cesarean deliveries is prepared and cryopreserved under sterile conditions and can be sutured onto the ocular surface. This procedure allows for reepithelialization of persistent corneal ulcerations as well as filling of stromal defects. Amniotic membrane can successfully be employed for ocular surface reconstruction following large corneal excisions and in the context of limbal stem cell disease for pterygium surgery as well as for various kinds of reconstruction of the conjunctiva. Taken together, amniotic membrane transplantation can serve as a valuable tool for ocular surface reconstruction, especially in the context of impaired epithelial function.

PMID: 9545790 [PubMed - indexed for MEDLINE]

Amniotic membrane transplantation for persistent epithelial defects with ulceration.

• Lee SH,
• Tseng SC.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Florida.

PURPOSE: To determine whether preserved human amniotic membrane can be used as an alternative substrate for treating persistent corneal epithelial defects with sterile ulceration. METHODS: Amniotic membrane transplantation was performed in 11 eyes of 11 consecutive patients with corneal ulcers of different causes that had persisted for a mean +/- SD of 17.5 +/- 13.9 weeks. RESULTS: Ten patients healed in 3.9 +/- 2.3 weeks (P < .01) without recurrence for 9.0 +/- 5.9 months. One patient failed to heal because of preexisting corneal perforation pursuant to severe rheumatoid arthritis. CONCLUSION: Amniotic membrane transplantation may be considered an alternative method for treating persistent epithelial defects and sterile ulceration that are refractory to conventional treatment and before considering treatment by conjunctival flaps or tarsorrhaphy.

PMID: 9063239 [PubMed - indexed for MEDLINE]

[Use of fresh amnion in the treatment of corneal diseases]

• Batmanov IuE,
• Egorova KS,
• Kolesnikova LN.

The effects of fresh amnion on the course of morbid processes in corneal ulcers and burn disease of the anterior segment of the eye were investigated. The cornea was coated with amnion in 15 eyes with deep bacterial ulcers, in 10 eyes with herpetic ulcers of the cornea, and in 8 eyes with second and third-degree corneal and conjunctival burns. The amnion was obtained in cesarean section and fixed to the limbal conjunctiva with an uninterrupted suture all around. The next day after surgery the pain syndrome reduced, as did photophobia and blepharospasm in all the patients. In the group of patients with bacterial ulcers the cornea epithelialized on days 5-11, in those with herpetic ulcers on days 10-15, and in those with burns on days 8-12 after amnion coating. No cases with suppuration of the burnt surface when coated with the amnion were recorded. The amnion slid off the cornea on days 7-10 after it was layered on.

PMID: 2264219 [PubMed - indexed for MEDLINE]

Further studies of changes on the chick embryo eyes after inoculation of tric agents into the amniotic cavity.

• Harisijades S,
• Arambasic M,
• Biga S,
• Harisijades B.

PMID: 5592051 [PubMed - indexed for MEDLINE]

Amniotic membrane grafts in corneal ulcer.

• SHUKLA IM.

PMID: 13988766 [PubMed - indexed for MEDLINE]