Amniotic Membrane Transplantation With Anterior Stromal Micropuncture for Treatment of Painful Bullous Keratopathy in Eyes With Poor Visual Potential.

• Sonmez B,
• Kim BT,
• Aldave AJ.

From the *The Jules Stein Eye Institute, University of California., Los Angeles Medical Center, Los Angeles, CA; daggerPennsylvania State University, College of Medicine, Hershey, PA.

PURPOSE:: To report the use of anterior stromal micropuncture and amniotic membrane transplantation in the management of painful bullous keratopathy in patients with poor visual potential. METHODS:: Interventional case series. A retrospective review was performed to identify all patients who were treated by one of us (A.J.A.) between January 1, 2003, and June 30, 2005. RESULTS:: Five eyes of 5 patients were identified. Conjunctival scarring secondary to glaucoma and retinal surgeries prevented mobilization of the conjunctiva in each of the patients identified. Each eye showed an intact, smooth corneal epithelial surface 1 month after the procedure, and no patients developed recurrent bullae formation during the follow-up period (average follow-up, 21 months; range, 11-34 months). CONCLUSIONS:: Anterior stromal micropuncture and amniotic membrane transplantation is an effective technique for the management of bullous keratopathy in patients with poor visual potential. The success rate of this combined procedure may exceed that of either procedure performed alone.

PMID: 17251820 [PubMed - as supplied by publisher]

[Palliative treatment in bullous keratopathy]

• Zemba M.

Spitalul Clinic de Urgenta Militar Central.

The article is a review of the possibilities of palliative treatment for bullous keratopathy, medical methods (hypotensor and hyperosmotic agents) and surgical methods (conjunctival flap, annular keratotomy, anterior stromal puncture, therapeutic photo-keratectomy and amniotic membrane use), each of them with indications, results, advantages and disadvantages.

PMID: 16927753 [PubMed - indexed for MEDLINE]

[Amnion and ocular surface problems]

• Giasson CJ,
• Bouchard C,
• Boisjoly H,
• Germain L.

Ecole d'Optometrie, Universite de Montreal, CP 6128, Succursale Centre-ville, Montreal, Quebec, J1H 5N4 Canada. giassonc@opto.umontreal.ca

The amniotic membrane, the most internal placental membrane, has various properties useful in ophthalmology. Collected on delivery by elective Caesarean section, the amnion is prepared under sterile conditions, and, usually, cryopreserved until its use as a biological bandage or as a substrate for epithelial growth in the management of various ocular surface conditions. Specifically, the amnion is used to : (1) limit formation of adhesive bands between eyelids and eyeball (symblepharon) or the progression of a fibrovascular outgrowth towards the cornea (pterygium) or to (2) facilitate the healing of corneal ulcers, bullous keratopathy, and corneal stem cell deficiency. In this last condition, either hereditary or acquired after a thermal or a chemical burn, corneal stem cells, located at a transitional zone between the cornea and conjunctiva, are lost. These cells are essential for renewal of corneal epithelium in normal and in diseased states. The loss of these cells leaves the corneal surface free for invasion by conjunctival epithelium. Not only, does conjunctival epithelium support the development of vascularisation on the normally avascular cornea, but some conjunctival cells differentiate into mucus secreting goblet cells. Such a change in phenotype leads to loss of corneal transparency and visual disability. The removal of this fibro-vascular outgrowth in combination with transplantation of both amniotic membrane and corneal stem cells are used to treat this condition. The amnion stimulates the proliferation of less differentiated cells which have the potential to reconstruct the cornea. This potential is at the origin of the hypothesis that the amnion may provide an alternative niche for limbal stem cells of the corneal epithelium. It abounds in cytokines and has antalgic, anti-bacterial, anti-inflammatory and anti-immunogenic properties, in addition to allowing, like fetal skin does, wound healing with minimal scar formation. These desirable properties are responsible for the increasing use of amniotic membrane in ophthalmology. The complete understanding of the mechanisms of action of amniotic membrane for ocular surface diseases has yet to be understood. Once revealed by research, they may provide new pharmacological avenues to treat ocular surface diseases.

PMID: 16828041 [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]

[A case of severe glaucoma with pseudopemphigoid successfully treated by filtration surgery using amniotic membrane]

• Hino K,
• Mori K,
• Sotozono C,
• Ikeda Y,
• Naruse S,
• Ishibashi T,
• Nanjo Y,
• Kinoshita S.

Department of Ophthalmology, Kyoto Prefectural University of Medicine Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-0841, Japan.

BACKGROUND: It is necessary to decrease topical anti-glaucoma medication for severe glaucoma with pseudopemphigoid caused by anti-glaucoma eye drops. Glaucoma filtrating surgery is often needed instead of medication, but the prognosis is poor because it induces scar fomation and makes the filtrating bleb vanish. CASE: An 85-year-old male patient with exfoliation syndrome had twice undergone glaucoma surgery about ten years previously. His intra-ocular pressure (IOP) was high despite topical anti-glaucoma medication. At the first examination in our hospital, he had severe superficial punctate keratopathy, blephariticshortening and symblepharon, and we therefore diagnosed severe pseudopemphigoid induced by anti-glaucoma eye drops. Because his IOP could not be controlled by topical and general medication, we conducted a glaucoma filtrating operation using amniotic membrane. CONCLUSION: The administration of oral anti-inflammatory drugs before and after surgery and the use of amniotic membrane prevented post-operative scar formation and the progress of symblepharon, resulting in the successful control of IOP after surgery.

PMID: 16642950 [PubMed - indexed for MEDLINE]

A novel application of amniotic membrane in patients with bullous keratopathy.

• Lee HI,
• Ha SW,
• Kim JC.

Department of Ophthalmology, College of Medicine, Chung-Ang University, Yongsan-gu, Seoul, Korea.

To evaluate the efficacy of amniotic membrane in the management of painful bullous keratopathy secondary to the intractable glaucoma and in preventing exposure of drainage devices, we inserted Ahmed valve with amniotic membrane patch graft over the implant itself, and debrided corneal epithelium with amniotic membrane graft over the exposed stroma as a single operation. During the follow-up periods, we monitored vision, intraocular pressure (IOP), presence of ocular pain, and postoperative complications associated with the implants. The mean follow up period was 8.4+/-3.2 months. IOP was well controlled after the intervention. The preoperative mean IOP was measured as 43.9+/-9.0 mmHg and lowered to 16.1+/-1.8 mmHg at the last visit and no complications associated with the implants were noted. Even though the improvement in vision was not prominent, the ocular surface stabilized rapidly and ocular pain associated with bullous keratopathy disappeared soon after surgery. Conclusively the use of amniotic membrane in conjunction with Ahmed valve implantation is an effective way to relieve ocular pain and lessen the chances of complications associated with the implant in patients with intractable glaucoma and bullous keratopathy.

PMID: 16614522 [PubMed - indexed for MEDLINE]

Detection of corneal epithelial defect through amniotic membrane patch by fluorescein.

• Kobayashi A,
• Ijiri S,
• Sugiyama K,
• Di Pascuale MA,
• Tseng SC.

Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan. kobaya@kenroku.kanazawa-u.ac.jp

PURPOSE: To demonstrate the usefulness of fluorescein dye to detect a corneal epithelial defect through an amniotic membrane patch in 4 cases. PATIENTS AND METHOD: Two patients with painful bullous keratopathy, 1 patient with total limbal deficiency, and 1 patient with acute chemical burn underwent surgeries in conjunction with amniotic membrane as patch. Postoperatively, slit-lamp biomicroscopic examination with and without fluorescein staining was performed. RESULTS: The status of epithelialization, ie, corneal epithelial defect on either denuded corneal stroma or amniotic membrane graft, was indiscernible by slit-lamp biomicroscopy through the amniotic membrane patch. Nevertheless, it could be detected by fluorescein staining, especially after saline rinse, in all 4 cases. CONCLUSIONS: Fluorescein staining permits clinicians to avoid prematurely removing the amniotic membrane patch during the treatment of a persistent corneal epithelial defect.

PMID: 15778616 [PubMed - indexed for MEDLINE]

Delayed healing of corneal epithelium after phototherapeutic keratectomy for lattice dystrophy.

• Das S,
• Langenbucher A,
• Seitz B.

Department of Ophthalmology, University of Erlangen-Nurnberg, Erlangen, Germany.

PURPOSE: To evaluate the time period necessary for complete epithelial healing after phototherapeutic keratectomy (o-PTK) carried out for various superficial corneal opacities. SUBJECTS AND METHOD: A total of 197 eyes were divided into 9 groups: group 1, Cogan dystrophy including recurrences (n = 15); group 2, Reis Bucklers dystrophy including recurrences (n = 12); group 3, granular dystrophy including recurrences (n = 63); group 4, lattice dystrophy including recurrences (n = 19); group 5, macular dystrophy including recurrences (n = 10); group 6, herpetic scars (n = 5); group 7, corneal scars of nonherpetic origin (including scrofulous, traumatic, central keratoconus, post-pterygium surgery) (n = 31); group 8, Salzmann nodular degeneration (n = 22); and group 9, miscellaneous (such as bullous keratopathy, acute chemical burn, corneal degeneration) (n = 20). After o-PTK, patients were examined daily at the slit lamp using fluorescein and blue light. The time period necessary for complete healing of the epithelial defect was compared among these groups. Delayed healing was considered where the epithelium was not closed after 7 days. RESULT: One hundred sixty-one eyes (95%) healed within 7 days. Overall, 63%, 80%, and 85% of epithelial defects were closed within 3, 4, and 5 days, respectively. Out of 9 eyes that had delayed healing, 6 eyes (67%) belonged to lattice dystrophy category. Mean time taken for healing in group 4 (8.6 +/- 8.4 days) was significantly longer than those in group 1 (3.0 +/- 1.5 days, P = 0.009), group 2 (3.7 +/- 3.1 days, P = 0.03), group 3 (3.1 +/- 1.5 days, P = 0.001), group 5 (2.7 +/- 0.8 days, P = 0.01), group 7 (3.6 +/- 2.4 days, P = 0.007), group 8 (3.3 +/- 1.3 days, P = 0.009), and group 9 (3.0 +/- 1.9 days, P = 0.011). CONCLUSION: Eyes with lattice corneal dystrophy suffered from delayed epithelial healing after o-PTK. In addition to adequate counseling, these patients should be followed up closely until complete closure of the epithelium to avoid ulceration, scarring, or even infection. These eyes might need additional treatment such as hyaluronic acid drops, autologous serum drops, simultaneous amniotic membrane patching, or even temporary lateral tarsorrhaphy.

PMID: 15778599 [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]

Microwave-superheated Vics Vapo Rub: an ocular public health danger.

• Fung AE,
• Oxford KW.

Department of Ophthalmology, Stanford University Medical Center, San Francisco, California, USA. annefungmd@yahoo.com

PURPOSE: To report a case of a microwave-oven superheated petroleum-based liquid causing severe chemical and thermal ocular burns treated successfully with amniotic membrane transplantation. DESIGN: Observational case report. METHODS: Retrospective review of clinical case. RESULTS: A 77-year-old woman sustained a severe combined chemical and thermal burn from microwave-heated Vicks Vapo-Rub requiring amniotic membrane transplant, with subsequent development of phacomorphic glaucoma, requiring cataract extraction, and bullous keratopathy, requiring penetrating keratoplasty. CONCLUSIONS: As microwave oven use becomes more commonplace, the risk of superheating liquids becomes an increasingly significant ocular danger. Continued efforts to educate the public about safe microwave use is necessary. Additionally, amniotic membrane transplantation was found to be effective in managing a combined chemical and thermal ocular burn.

PMID: 14962445 [PubMed - indexed for MEDLINE]

[Monolayered amniotic membrane transplantation as a palliative treatment for bullous keratopathy]

• Lopez Ferrando N,
• Celis Sanchez J,
• Gonzalez Del Valle F,
• Lopez Mondejar E.

Servicio de Oftalmologia, Complejo Hospitalario Mancha Centro, Alcazar de San Juan (Ciudad Real), Spain. nlopezf@jazzfree.com

PURPOSE: To determine the efficacy of monolayered amniotic membrane transplantation for short and medium-term symptomatic improvement in those cases of bullous keratopathy where a penetrating keratoplasty is not indicated. METHODS: Amniotic membrane transplantation was performed in five patients with symptomatic bullous keratopathy in which penetrating keratoplasty was not indicated. Data about bandage contact lens need before and after surgery, existence of ocular pain, occurrence and extension of bullae, epithelial defects, and persistence of amniotic membrane, were obtained at days 4 and 14, and months 1, 2, 4 and 6 after surgery. RESULTS: No pain, bullae or epithelial defects were present at day 14 in any patient. However, progressive dissolvement of the amniotic membrane was accompanied with more bullae and pain. At 6th month, 4 of 5 patients required bandage contact lens. CONCLUSION: Amniotic membrane transplantation alleviates short-term symptomatic bullous keratopathy and preserves corneal anatomy. Six months after surgery, anatomical and symptomatic improvement does not avoid the need of bandage contact lens.

PMID: 14752699 [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]

[Transplantation of amniotic membrane for patients with bullous keratopathy and chemical and thermal burns]

• Siennicka A,
• Pecold-Stepniewska H,
• Czajka M.

Katedry i Kliniki Okulistycznej Akademii Medycznej im. K. Marcinkowskiego w Poznaniu.

The aim of this paper is, to evaluate the efficacy of amniotic membrane transplantation for ocular surface reconstruction in patients with bullous keratopathy and chemical and thermal burns of cornea and conjunctiva. Amniotic membrane is a thin, semitransparent tissue forming an innermost layer of the fetal membrane, which contains a thick basement membrane with a single layer of epithelium and avascular matrix. This transplantation promotes normal conjunctival epithelization while suppressing fibrosis formation. Amniotic membrane transplant may be considered as an alternative method for treating ocular surface reconstruction in patients with thermal and chemical burns. Authors suggest that this method of treatment is not efficient in patients with bullous keratopathy.

PMID: 12866170 [PubMed - indexed for MEDLINE]

Amniotic membrane transplantation for bullous keratopathy in eyes with poor visual potential.

• Espana EM,
• Grueterich M,
• Sandoval H,
• Solomon A,
• Alfonso E,
• Karp CL,
• Fantes F,
• Tseng SC.

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

PURPOSE: To evaluate the long-term outcomes of epithelial debridement and amniotic membrane transplantation (AMT) for pain and discomfort relief in patients with symptomatic bullous keratopathy and poor visual potential. SETTING: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA. METHODS: This retrospective study included 18 eyes (18 patients) with bullous keratopathy presenting with intractable pain or discomfort and poor visual potential. After epithelial debridement, all eyes had AMT with the basement membrane side up. During a mean follow-up of 25.1 months +/- 9.6 (SD) (range 12 to 45 months), pain relief, epithelial healing, and visual changes were analyzed. RESULTS: Pain relief was obtained in 88% of patients. Sixty-six percent of eyes had complete resolution of ocular discomfort starting soon after the first postoperative day. One eye had evisceration for persistent pain 10 months postoperatively. Corneal epithelial healing was complete in all except 1 eye. Remaining complaints included foreign-body sensation (5%), tearing (11%), and photophobia (5%). CONCLUSIONS: Amniotic membrane transplantation was a safe, effective, and long-lasting treatment modality for intractable pain associated with chronic bullous keratopathy in eyes with poor visual potential. It can be an alternative to conjunctival flaps for the long-term management of patients with bullous keratopathy in whom corneal transplantation is not indicated. A comparison of the efficacy of AMT with that of other surgical procedures must be performed.

PMID: 12648638 [PubMed - indexed for MEDLINE]

Comment on:

Cornea. 2002 May;21(4):342-5.

Response to symptomatic management of postoperative bullous keratopathy with nonpreserved human amniotic membrane.

• Panda A,
• Pangtey MS,
• Sony P.

PMID: 12605061 [PubMed - indexed for MEDLINE]

Amniotic membrane transplantation for ocular surface reconstruction.

• Petric I,
• Ivekovic R,
• Tedeschi-Reiner E,
• Novak-Laus K,
• Lacmanovic-Loncar V,
• Bradic-Hammoud M.

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

The purpose of this study is to analyze the clinical experience and the effect of human amniotic membrane transplantation on pterygium excision and bullous keratopathy. From January 1999 to January 2001 at University Hospital "Sestre milosrdnice" amniotic membrane transplantation was performed consecutively in 21 eyes: 11 eyes with bullous keratopathy and 10 with recurrent pterygia. In the group with bullous keratopathy epithelization took place in 19.6 days in 72.7% and the reduction of pain was satisfactory. Recurrence rate in group with recurrent pterygia was 20%. Based on the presented results it could be concluded that amniotic membrane transplantation can be considered as an effective alternative for treating severe ocular surface diseases and as an alternative for penetrating keratoplasty if there is a lack of grafts.

PMID: 12528291 [PubMed - indexed for MEDLINE]

[Amniotic membrane transplantation in severe corneal epithelial diseases. Preliminary results]

• Zito E,
• Borderie V,
• Touzeau O,
• Bourcier T,
• Allouch C,
• Laroche L.

Pole hospitalo-universitaire d'Ophtalmologie Saint Antoine-Quinze-Vingts, Centre Hospitalier National d'Ophtalmologie des XV-XX, 28, rue de Charenton, 75571 Paris Cedex 12, France.

PURPOSE: To evaluate amniotic membrane transplantation (AMT) in severe corneal epithelial diseases. METHODS: Amniotic membrane transplantation was performed in 14 eyes of 14 patients from four groups: A, five severe ocular burns; B, four cases of cicatricial keratoconjunctivitis; C, three persistent epithelial defects after penetrating keratoplasty; D, two cases of pseudophakic bullous keratopathy. Five patients underwent AMT alone; two patients underwent AMT combined with limbal transplantation; the other three patients had limbal transplantation performed before AMT. Eight patients required combined penetrating keratoplasty. Patients with corneal stable reepithelialization, no corneal neovascularization, and no recurrence of the initial pathology were considered successful. RESULTS: The mean follow-up was 7+/-3 months. All but three patients underwent corneal reepithelialization within 6 weeks of AMT, with a mean healing time of 31+/-23 days. The success rate was 75% at 6 months (Kaplan-Meier method). Three of four procedures in group B failed. In eight patients, visual acuity improved, in one it worsened, and in the last five patients it remained unchanged. Visual acuity increased by an average of 7+/-9 lines. CONCLUSION: AMT is a useful technique for ocular surface reconstruction, especially in association with limbal transplantation. It could also improve the prognosis of penetrating keratoplasty in patients with severe corneal conditions.

PMID: 12515931 [PubMed - indexed for MEDLINE]

[Use of amniotic membrane transplantation for treating bullous keratopathy]

• Mrukwa-Kominek E,
• Gierek-Ciaciura S,
• Rokita-Wala I,
• Szymkowiak M.

I Katedry i Kliniki Okulistyki Slaskiej Akademii Medycznej w Katowicach.

One of the complications of cataract surgery is bullous keratopathy, which is the result of decompensation of the corneal endothelium. The clinical signs are manifested in stromal and epithelial edema with bullae producing. The amniotic membrane, which is taken from the placenta of young mothers during the caesarean section, may have beneficial influence on the process of healing the corneal structure. The study aimed to evaluate effectiveness of bullous keratopathy treatment using amniotic membrane transplantation, as an alternative method of treatment after cataract surgery. MATERIAL AND METHODS: The amniotic membrane transplantation was performed in 18 eyes of 18 patients (10 females and 8 males), aged 62 to 85 with the bullous keratopathy. After removing the pathologically changed epithelium, the amniotic membrane was covered on cornea in local anesthesia, using interrupted sutures 10.0 nylon. A therapeutic contact lens were applied. Control examinations were performed 3, 6 and 12 weeks after the operation. The best corrected visual acuity was evaluated. The local state was investigated using slitbiomocroscopy and confocal microscopy. RESULTS: In all the patients' regression of subjective complaints was observed (pain, light sensitivity and tearing). In 12 cases improvement of visual acuity was achieved. The evaluation of corneas in slit biomicroscopy revealed greater clarity and less corneal edema. On confocal microscopy, decrease in blurred collagen fibers and background illumination were observed. The epithelium contained cystic structures (blisters) in 6 cases only. The endothelial cells were pleomorphic and polymegathic. CONCLUSION: The amniotic membrane transplantation is an effective method of treatment for bullous keratopathy and has beneficial influence on the process of corneal healing and the improvement of visual acuity and diminish subjective symptoms.

PMID: 12046309 [PubMed - indexed for MEDLINE]

Comment in:

Cornea. 2003 Mar;22(2):187; author reply 187-8.

Symptomatic management of postoperative bullous keratopathy with nonpreserved human amniotic membrane.

• Mejia LF,
• Santamaria JP,
• Acosta C.

Cornea Service Instituto de Ciencias de la Salud-CES Medellin, Colombia. lfmejia@epm.net.co

PURPOSE: To report the results of the management of painfully symptomatic postoperative bullous keratopathy (PBK) by performing a nonpreserved human amniotic membrane (NP-AMT) transplantation in nine eyes with poor visual potential. METHODS: A prospective, comparative, nonrandomized management of symptomatic PBK was done by performing a complete corneal de-epithelialization followed by a NP-AMT transplantation (NP-AMT group) or no NP-AMT transplantation (control group). We evaluated time for re-epithelialization, patient's symptoms, and appearance of new bullae. RESULTS: In the NP-AMT group, mean follow-up time was 40 weeks. Mean re-epithelialization time was 11.2 days. Symptoms of PBK resolved completely in eight patients (88%), who were asymptomatic and showing very quiet eyes from postoperative day 1, and resolved partially in one patient in whom we observed barely symptomatic bullae at the peripheral NP-AMT border (sixth postoperative week) and an asymptomatic one at the corneal center under the NP-AMT (seventh postoperative week). In the control group, mean follow-up time was 18 weeks; there were recurrences of symptomatic bullae in four of five patients at a mean time of 6.3 days. CONCLUSIONS: NP-AMT is a good alternative for the management of painful PBK in eyes with poor visual potential; NP-AMT is widely available, the technique is easy to perform, and it has good results from both the symptomatic and esthetic standpoint.

PMID: 11973379 [PubMed - indexed for MEDLINE]

[Amniotic membrane transplantation for reconstruction of the ocular surface]

• Kruse FE,
• Meller D.

Augenklinik der Universitat Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg. Friedrich_Kruse@med.uni-heidelberg.de

Amniotic membrane transplantation has been recently gained wide-spread attention as a new method for reconstruction of the ocular surface. However long term prognosis of the surgical intervention as well as action mechanism are poorly defined. Therefore, we review the current literature concerning the application of amniotic membrane in ophthalmology and the outcome of the surgery. Amniotic membrane is used as graft or patch to promote epithelial healing of persistent epithelial defects, corneal ulcers and following penetrating keratoplasty. It is also used to seal corneal perforations and to treat bullous keratopathy. Amniotic membrane patches facilitate epithelial healing and reduce the number of complications after chemical burns. For partial limbal deficiency, amniotic membrane alone can be sufficient, while total limbal deficiency requires combination with stem-cell transplantation. Furthermore amniotic membrane grafts restore conjunctival surfaces following removal of lesions such as pterygium, tumor, scar, symblepharon, and conjunctivochalasis. The prognosis of amniotic membrane transplantation depends on the underlying disease and the quality of the ocular surface and is inversely related to the degree of inflammation. Recent investigations of the action mechanisms describe intrinsic antiinflammatory properties of the amniotic membrane.

PMID: 11594219 [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]

Amniotic membrane transplantation for symptomatic bullous keratopathy.

• Pires RT,
• Tseng SC,
• Prabhasawat P,
• Puangsricharern V,
• Maskin SL,
• Kim JC,
• Tan DT.

Ocular Surface and Tear Center, Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, FL 33136, USA.

OBJECTIVE: To determine whether amniotic membrane transplantation can be used to treat symptomatic bullous keratopathy displaying poor visual potential. METHODS: Amniotic membrane transplantation was performed at 5 centers on 50 consecutive eyes (50 patients) with symptomatic bullous keratopathy and poor visual potential. The underlying causes of bullous keratopathy included aphakia (9 eyes), pseudophakia (19 eyes), failed grafts (9 eyes), and others (13 eyes). RESULTS: During the follow-up period of 33.8 weeks (3-96 weeks) after amniotic membrane transplantation, 43 (90%) of 48 eyes with intolerable pain preoperatively became pain free postoperatively. Among the 5 eyes with residual pain, 3 received repeated amniotic membrane transplantation, 1 required a conjunctival flap for pain relief, and 1 had reduced pain. Epithelial defects in 45 (90%) of 50 eyes created and covered by amniotic membrane healed rapidly within 3 weeks. Only 4 eyes (8%) showed recurrent surface breakdown. Epithelial edema or bullae recurred in a smaller area in 5 eyes (10%) and pseudopterygium developed in 1 eye. CONCLUSION: Amniotic membrane transplantation can be considered as an alternative to conjunctival flaps in alleviating pain, promoting epithelial healing, and preserving cosmetic appearance in patients with symptomatic bullous keratopathy and poor visual potential.

PMID: 10532436 [PubMed - indexed for MEDLINE]