Using an improved multilayer amniotic membrane transplantation technique
K. V. Sereda, G. I. Drozhzhyna, T. B. Gaidamaka
SI "The Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine"; Odesa (Ukraine)
Sereda KV, Drozhzhyna GI, Gaidamaka TB. Using an improved multilayer amniotic membrane transplantation technique http://doi.org/10.31288/oftalmolzh2022239
Background: Amniotic membrane (AM) is widely used in ophthalmic surgery. There are three major techniques for amniotic membrane transplantation (AMT): ‘onlay’ (‘patch’) technique, ‘inlay’ (‘multilayer transplantation’) and ‘sandwitch’ technique (a combination of the two techniques mentioned before), but there is no universal technique for placing the amnion on the ocular surface for AMT. In conventional multilayer AMT, the membrane is fixed layer by layer with numerous interrupted sutures, which contributes to a severe corneal inflammatory response and the formation of intense corneal opacity.
Purpose: To improve the multilayer amniotic membrane transplantation technique.
Material and Methods: The method proposed by us consists in forming a two layer or three layer amniotic graft and anchoring it to the surrounding cornea by a row of interrupted 10-0 sutures. Twenty eight patients with corneal ulcers of different causes underwent amniotic membrane transplantation. There were 17 men (60.7%) and 11 women (39.3%). Mean patient age (standard deviation) was 51.3 (0.81) years. Corneal ulcers were categorized based on the etiology as herpetic (7/28, 25%), neurotrophic (10/28, 35.7%), bacterial (3/28, 10.7%), fungous (2/28, 7.2%), autoimmune (3/28, 10.7%) and those caused by rosacea (3/28, 10.7%).
Results: After AMT by the proposed technique, there was a reduction in corneal stromal edema at discharge (χ2 = 29.7; p = 0.0005). In addition, corneal stromal infiltration resorbed at 1 month after surgery compared to at discharge (χ2 = 9.16; p = 0.0025). AMT by the proposed technique facilitated the formation of mild focal corneal opacity in 26 patients (92.8%).
Conclusion: Our improved AMT technique reduces the number of sutures on the cornea, enables filling the corneal stromal defect and contributes to decreased inflammatory response and early epithelialization of the corneal surface.
Keywords: human amniotic membrane, transplantation, corneal ulcer, interrupted sutures
Conflict of Interest Statement. The authors declare no conflict of interest.
Funding Support. There are no external sources of funding.
1.Abdulhalim BE, Wagih MM, Gad AA, Boghdadi G, Nagy RR. Amniotic membrane graft to conjunctival flap in treatment of non-viral resistant infectious keratitis: a randomised clinical study. Br J Ophthalmol. 2015 Jan;99(1):59-63.
2.Grau AE, Duraxn JA. Treatment of a large corneal perforation with a multilayer of amniotic membrane and tachoSil. Cornea. 2012 Jan;31(1):98-100.
3.Liu J, Li L, Li X. Effectiveness of Cryopreserved Amniotic Membrane Transplantation in Corneal Ulceration: A Meta-Analysis. Cornea. 2019;38:454–462.
4.Smal RM. [Pathogenetic grounds for and efficacy of amniotic membrane transplantation for non-infectious corneal ulcers]. [Cand Sc (Med) Thesis]. Odesa: Filatov Institute of Eye Diseases and Tissue Therapy; 2007. Russian.
5.Schroeder A, Theiss C, Steuhl KP, Meller K, Meller D. Effects of the human amniotic membrane on axonal outgrowth of dorsal root ganglia neurons in culture. Curr Eye Res. 2007 Sep;32(9):731-8.
6.Ueta M, Kweon MN, Sano Y. Immunosuppressive properties of human amniotic membrane for mixed lymphocyte reaction. Clin Exp Immunol. 2002 Sep;129(3):464-70.
7.Sorsby A, Symons HM. Amniotic membrane grafts in caustic burns of the eye: (Burns of the second degree). Br J Ophthalmol. 1946 Jun;30(6):337-45.
8.Trufanov SV. [Use of human preserved amniotic membrane in ocular reconstructive surgery]. [Abstract of Cand Sc (Med) Thesis]. Moscow: Helmholtz Research Institute of Eye Diseases. Russian.
9.Lacorzana J. Amniotic membrane, clinical applications and tissue engineering. Review of its ophthalmic use. Arch Soc Esp Oftalmol (Engl Ed). 2020 Jan;95(1):15-23.
10.Sabater-Cruz N, Figueras-Roca M, González A, Padró-Pitarch L. Current clinical application of sclera and amniotic membrane for ocular tissue bio-replacement. Cell Tissue Bank. 2020. 2020 Dec;21(4):597-603.
11.Zemanová M, Pacasová R, Šustáčková J, Vlková E. Amniotic membrane transplantation at the department of ophthalmology of the University hospital BRNO. Cesk Slov Oftalmol. Spring 2021;77(2):62-71.
12.Arvola R, Holopainen J. Amnion in the treatment of ocular diseases. Duodecim. 2015;131(11):1044-9. Finnish.
13.Morikawa K, Sotozono C, Inatomi T, et al. Indication and Efficacy of Amniotic Membrane Transplantation Performed under Advanced Medical Healthcare. Nippon Ganka Gakkai Zasshi. 2016 Apr;120(4):291-5.
14.Paolin А, Cogliati E, Trojan D. Amniotic membranes in ophthalmology: long term data on transplantation outcomes. Cell Tissue Bank. 2016 Mar;17(1):51-8.
15.Röck T, Bartz-Schmidt KU, Landenberger J, Bramkamp M. Amniotic Membrane Transplantation in Reconstructive and Regenerative Ophthalmology. Ann Transplant. 2018 Mar 6;23:160-165.
16.Arya SK, Bhala S, Malik A, Sood S. Role of amniotic membrane transplantation in ocular surface disorders. Nepal J Ophthalmol. Jul-Dec 2010;2(2):145-53.
17.Malhotra C, Jain AK. Human amniotic membrane transplantation: Different modalities of its use in ophthalmology. World J Transplant. 2014 Jun 24;4(2):111-21.
18.Kheirkhah A, Johnson DA, Paranjpe DR, Raju VK, Casas V, Tseng SC. Temporary sutureless amniotic membrane patch for acute alkaline burns. Arch Ophthalmol. 2008 Aug;126(8):1059-66.
19.Thomasen H, Pauklin M, Steuhl KP, Meller D. Comparison of cryopreserved and air-dried human amniotic membrane for ophthalmologic applications. Graefes Arch Clin Exp Ophthalmol. 2009 Dec;247(12):1691-700.
20.Uhlig CE, Müller VC. Resorbable and running suture for stable fixation of amniotic membrane multilayers: A useful modification in deep or perforating sterile corneal ulcers. Am J Ophthalmol Case Rep. 2018 Apr 19;10:296-299.
21.Kogan S, Sood A, Granick MS. Amniotic Membrane Adjuncts and Clinical Applications in Wound Healing: A Review of the Literature. Wounds. 2018 Jun;30(6):168-173.
22.Dietrich T, Sauer R, Hofmann-Rummelt C, Langenbucher A, Seitz B. Simultaneous amniotic membrane transplantation in emergency penetrating keratoplasty: a therapeutic option for severe corneal ulcerations and melting disorders. Br J Ophthalmol. 2011 Jul;95(7):1034-5.
23.Brücher VC, Eter N, Uhlig CE. Results of Resorbable and Running Sutured Amniotic Multilayers in Sterile Deep Corneal Ulcers and Perforations. Cornea. 2020 Aug;39(8):952-956.
24.Jirsova K, GL Jones. Amniotic membrane in ophthalmology: properties, preparation, storage and indications for grafting-a review. Cell Tissue Bank. 2017 Jun;18(2):193-204.
25.Kasparov AA, Trufanov SV. [Use of preserved amniotic membrane for reconstruction of the surface of the anterior eye segment]. Vestn Oftalmol. May-Jun 2001;117(3):45-7. Russian.
26.Novytskyy IYa. [Place of amniotic membrane transplantation in treatment of corneal diseases accompanied by neovascularization]. Vestn Oftalmol. Nov-Dec 2003;(6):9-11. Russian.
27.Resch MD, Schlötzer-Schrehardt U, Hofmann-Rummelt C, Sauer R, Cursiefen C, et al. Adhesion Structures of Amniotic Membranes Integrated into Human Corneas. Invest Ophthalmol Vis Sci. 2006 May;47(5):1853-61.
28.Nubile M, Dua HS, Lanzini M, et al. In vivo analysis of stromal integration of multilayer amniotic membrane transplantation in corneal ulcers. Am J Ophthalmol. 011 May;151(5):809-822.e1.
29.Nubile M, Dua HS, Lanzini TE, et al. Amniotic membrane transplantation for the management of corneal epithelial defects: an in vivo confocal microscopic study. Br J Ophthalmol. 2008 Jan;92(1):54-60.
30.Sereda EV, Vit VV, Drozhzhina GI, Gaidamaka TB. [Corneal inflammation and proliferative activity of anterior epithelial cells in experimental bacterial keratitis and different types of amniotic membrane fixation]. Oftalmol Zh. 2016;1:36-42. Russian.
31.Sereda EV, Drozhzhina GI, Gaidamaka TB, et al. [Efficacy of different surgical techniques of amniotic membrane transplantation]. Oftalmol Zh. 2016;4:3-10. Russian.