Amniotic Membrane Transplantation for Corneal Indications

Overview


  • Superficial corneal opacity before AMT

  • Superficial corneal opacity after AMT

Our strategy for corneal surface reconstruction includes amniotic membrane transplantation (AMT). There are two modes for clinical use of AMT; permanent graft or overlaid graft.

When used as a permanent graft, the aim of AMT is to fill in the corneal stromal defect.

When used as a overlaid graft, the aim of AMT is to reduce ocular surface inflammation to promote epithelial healing with minimal or no scarring.

Indications for AMT as a permanent graft

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  • Non-healing Corneal Epithelial Defects/Ulcer/Descemetocele
  • Diagnosis of Conjunctivochalasis
  • AMT for Bullous and Band Keratopathy
Indications for AMT as a overlaid graft

[Expand all]

  • AMT After Superficial Keratectomy
  • AMT for Controlling Inflammation and Promoting Healing
  • AMT following High-Risk Corneal Transplantation
  • AMT for Corneal Degeneration
Persistent Epithelial Defects

Corneal ulcers are serious and urgent clinical problems that can be complicated by microbial infections and threaten patient's vision. Corneal ulcers can be caused by various insults (e.g., exogenously from chemical burns, infection, radiation, or surgeries, while endogenously from aging, diabetes mellitus, viral (herpes) infection, and autoimmune disorders) which have the common denominator - neurotrophic keratopathy. When all medical treatments fail and the ulceration persists, conventional surgical treatments include lamellar or full-thickness corneal transplantation (patch graft), tarsorrhaphy or conjunctival flap.

AMT offers the following advantages over corneal tissue use in the treatment of persistent epithelial defects:

  • avoidance of potential allograft rejection
  • postoperative astigmatism of tectonic corneal grafts
  • ease and convenience of use
  • feasibility in the event of corneal tissue shortage
  • preservation of a better aesthetic appearance
  • Even if corneal transplantation is needed, its success is promoted if performed in an eye that received AMT to reduce inflammation
Descemetocele and Perforation

For deeper stromal ulcers down to descemetocele, multiple layers of amniotic membrane (AM) can be used to restore the normal corneal thickness. When there is frank perforation even up to 3 mm in diameter, AMT may be used to seal the ulcer with or without additional tissue adhesive.

Infectious Keratitis and Scleritis

Corneal ulcers due to bacterial, fungal or viral causes can be managed by AMT after controlling the infection with proper antimicrobial treatment. This procedure results in decreased melting and inflammation at the lesion site with re-epithelialization within 2-3 weeks. Also it decreases the recurrence of infection.

Bullous Keratopathy

Bullous keratopathy is a disorder caused by corneal endothelial decomposition due to degeneration (Fuch's endothelial dystrophy), surgical trauma, intractable glaucoma, or previous corneal graft failure. For those who do not have a visual potential, relief of pain and recurrent erosion will rely on several surgical treatments including cauterization, anterior stromal puncture, excimer laser photoablation, and conjunctival flap. After epithelial debridement, AMT provides pain relief and healing in addition to creating a smooth corneal epithelial surface 1 month after the procedure, and no recurrent bullae formation.

Band Keratopathy

Band keratopathy occurs in a number of corneal diseases characterized bchronic inflammation. Conventional treatments include chelation by EDTA and superficial keratectomy to remove superficial calcium deposit and corneal stromal tissue. AMT after this procedure has achieved a success rate of more than 90% in relieving patient's pain, establishing a stable corneal epithelium, and in some eyes improved vision.

Documents

Pubmed.gov list of published papers

Videos


  • Corneal Defect Treatment Overview Video

  • Office treatment of corneal defect Video

  • Band Keratopathy Surgery Video

  • Band & Bullous Keratopathy Surgery Video

  • Acute Treatment for Severe Ocular Surface Inflammation Overview Video


  • Surgical Treatment of Acute Chemical Burn with Amniotic Membrane Video


  • Treatment of Acute Chemical Burn with Amniotic Membrane Video


  • Corneal Transplantation Surgery Video
     


  • High-Risk Corneal Transplantation Surgery Video


  • PRK/PTK Surgery Video
     


  • Salmann's Nodular Degeneration using amniotic membrane transplantation Video


If you have additional surgical questions after viewing this information, contact OSREF's Research Director, Scheffer C.G. Tseng, MD, PhD, by e-mail at stseng@ocularsurface.com or by phone at 305-274-1299.

Videos edited by: Scheffer C.G. Tseng, MD, PhD, Hosam Sheha, MD, PhD, Ahmad Kheirkhah, MD, Antonio Elizondo, MD, Victoria Casas, MD

Note: The videos are for peer discussion purposes and the creators are not participating in commercial promotion of any product.

Financial Interest Disclosure: Dr. Tseng and his family are more than 5% shareholders in TissueTech, Inc. and Bio-Tissue, Inc. which currently distributes AMNIOGRAFT® and PROKERA™

Copyright © 2011 Ocular Surface Research & Education Foundation. Content is protected under intellectual property laws and are licensed for non-commercial viewing only. Any distribution, copying transmission or alteration is prohibited. All rights reserved.