Efficacy of different amniotic membrane transplantation techniques in patients with inflammatory and degenerative pathology of the cornea
E. V. Sereda, a post-graduate student
G. I. Drozhzhina, Dr Sc (Med), Prof.
T. B. Gaidamaka, Dr Sc (Med)
E.V. Ivanovskaia, Cand Sc (Med)
V.L. Ostashevskii, Cand Sc (Med)
O.N. Ivanova, Cand Sc (Med)
B.M. Kogan, Cand Sc (Med)
Filatov Institute of Eye Diseases and Tissue Therapy, NAMS of Ukraine
Introduction. Due to its unique properties, amniotic membrane transplantation took its place in reconstructive surgery of ocular surface. The standard technique for amniotic membrane transplantation does not exist.
Purpose. To compare the efficacy of different amniotic membrane transplantation techniques in patients with inflammatory and degenerative pathology of the cornea, according to archival patient's cases.
Material and Methods. The analysis of 65 archival patient's cases, who underwent amniotic membrane transplantation was made. Three amniotic membrane transplantation technique were used: inlay (graft transplantation), onlay (biological covering), sandwich (combined technique). After the operation, a bandage soft contact lens was put on the corneal surface with fixed amniotic membrane. In the case of amniotic membrane transplantation combined with blepharorrhaphy contact lens was not used.
Results. Our study showed high efficacy of amniotic membrane transplantation in patients with different pathologies of the cornea (recurrent pterygium, bullous form of endothelial-epithelial corneal dystrophy), keratitis (bacterial, neurotrophic, autoimmune and herpetic) and corneal burns. In 62 patients (95.4%), positive therapeutic effect was obtained with corneal epithelialization activation, elimination of inflammation and pain, and the absence of pterygium recurrences. It was found that among the patients who had underwent an inlay-technique of amniotic membrane transplantation, the highest efficacy was noted in patients with herpetic and bacterial ulcers. In the group of patients undergone an onlay-technique, the highest efficacy was noted in patients with endothelial-epithelial corneal dystrophy and neurotrophic keratitis and in patients with a sandwich-technique, the highest efficacy was in patients with autoimmune corneal ulcers.
Conclusions. There is no one opinion about the best surgical technique of amniotic membrane transplantation. That's why the pilot study on the amniotic membrane transplantation efficacy and the effect on the course of inflammation in the corneal tissue depending on type of its fixation is of scientific and practical interest.
Key words: аmniotic membrane, cryopreservation, graft technique, biological covering.
- Trufanov SV. Using preserved amniotic membrane in human reconstructive eye surgery: Author’s thesis for Cand. Of Med. Science. 14.00.08 Eye Diseases. M., 2004. 24 p. Russian.
- Fedorova EA. Application of lyophilized amniotic membrane in the treatment of inflammatory diseases of the cornea: Author’s thesis for Cand. Of Med. Science. 14.00.08 Eye Diseases. M., 2004. 24 p.Russian.
- De Rotth A. Plastic repair of conjunctival defects with fetal membrane. Arch. Ophthalmol. 1940;23:522–525.
- Dua HS, Gomes G, King A. The amniotic membrane in ophthalmology. Surv. Ophthalmol. 2004;49(1):51 -77.
- Espana EM, Prabhasawat P, Grueterich M, Solomon A, Tseng SC. Amniotic membrane transplantation for reconstruction after excision of large ocular surface neoplasias. Br. J. Ophthalmol. 2002;86:640–5.
- Hanada К. Treatment of persistent corneal epithelial defects with amniotic membrane. J/ Eye. 1999;16:1261-2.
- Hao Y, Ma DH, Hwang DG, Kim WS, Zhang F. Identification of antiangiogenic and antiinflammatory proteins in human amniotic membrane. Cornea. 2000;19(3):348-52.
- Iakymenko SA, Buznyk OI, Rymgayllo-Jankowska B. Amniotic membrane transplantation in treatment of persistent corneal ulceration after severe chemical and thermal eye injuries. Eur J Ophthalmol 2013; 23(4): 496 – 503.
- Koizumi NJ, Inatomi TJ, Sotozono CJ, Fullwood NJ, Quantock AJ, Kinoshita S. Growth factor mRNA and protein in preserved human amniotic membrane. Curr. Eye Res. 2000;20:173–7.
- Lee SB, Li DQ, Tan DT, Meller DC, Tseng SC. Suppression of TGF-beta signaling in both normal conjunctival fibroblasts and pterygial body fibroblasts by amniotic membrane.Curr. Eye. Res. 2000;20: 325–34.
- Seitz B. Amniotic membrane transplantation. An indispensable therapy option for persistent corneal epithelial defects. Ophthalmologe. 2007;104:1075–9.
- Sippel KC, Ma JJ, Foster CS. Amniotic membrane surgery. Curr. Opin. Ophthalmol. 2001;12: 269–281.
- Shortt AJ, Secker GA, Notara MD. Transplantation of ex vivo cultured limbal epithelial stem cells: a review of techniques and clinical results. Surv. Ophthalmol. 2007;52:483–502.
- Solomon A, Rosenblatt M, Monroy D, Ji Z, Pflugfelder SC, Tseng SC. Suppression of interleukin 1alpha and interleukin 1beta in human limbal epithelial cells cultured on the amniotic membrane stromal matrix. Br. J. Ophthalmol. 2001;85: 444–9.
- Touhami A, Grueterich M, Tseng SC. The role of NGF signaling in human limbal epithelium expanded by amniotic membrane culture. Invest. Ophthalmol. Vis. Sci. 2002;43:987–94.
- Tseng S, Prabhasawat P, Lee S. Amniotic membrane transplantation for conjunctival surface reconstruction. Am. J. Ophthalmol. 1997;124:765 – 74.