AMT After Superficial Keratectomy
If there was no significant stromal loss and the remaining stroma is smooth, AMT can be performed as an overlaid graft by either inserting PROKERA™ or suturing amniotic membrane (AMNIOGRAFT® size 1.5 x 1.0 cm or 2.0 x 1.5 cm) as a single layer to cover both corneal and perilimbal conjunctiva (as if a large bandage contact lens). Starting in the inferior quadrant, suture the amniotic membrane with a 10-O nylon suture in a purse-string running fashion about 3 mm from the limbus with 6 to 8 scleral bites. After tying, the end can be left long and the knot does not need to be buried.
If there was significant stromal loss and the remaining stroma is irregular, before an overlaid graft can be placed as described above, the defect is first filled in with additional layer(s) of amniotic membrane (AMNIOGRAFT® size 1.5 x 1.0 cm or 2.0 x 1.5 cm) using fibrin glue or 10-O nylon sutures.
Trim the membrane to the size of the defect. If fibrin glue is used to secure this bottom layer, the membrane should be placed on the eye surface outside of the defect area with stromal side up. Apply the thrombin component of the fibrin glue to the defect area and apply the 
fibrinogen component of the glue to the stromal surface of the AM, the membrane is flipped back to cover the defect with stromal surface down and a muscle hook is used to stretch the membrane over the defect. After the glue has set, trim the excess membrane from around the defect.
Alternately, AM can be secured to the corneal surface using 10-O nylon sutures.
Videos
Superficial Keratectomy Surgery Video: Superficial keratectomy for a patient with an unstable corneal epithelium that complained of blurry vision; ProKera used to assist in re-epithelialization; post-operative results discussed OSREF Superficial Keratectomy Surgery Sample
Superficial Keratectomy Surgery Video 2: Surgical procedure of debriding the corneal epithelial surface for a patient with focal corneal conjunctivalization and associated vision loss; Amniotic membrane attached to the resulting defect using fibrin glue and a ProKera device is used to assist in re-epithelialization; post-operative results discussed OSREF Superficial Keratectomy Surgery Sample 2
Papers
Click here to view PubMed.gov's list of published papers on Amniotic Membrane for Partial Limbal Stem Cell Deficiency. (To receive an updated list of papers availale, click the "Go" button next to the search box at the top of the page.)
Click here to view standard surgical supplies used for AMT.
Click here to view standard Post-operative care for AMT
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