Amniotic membrane transplantation: An option for ocular surface disorders

Abstract

Background: Ocular surface disorders (OSD) are challenging to treat. They can introduce serious morbidity and might even lead to visual loss. In such situations, keratoplasty remains the last option. Amniotic membrane transplantation (AMT) has been shown to be effective in the management of ocular surface pathologies. The aim of the study was to assess the efficacy of AMT for various indications of OSD.

Materials and methods: Experience of AMT in 65 patients with different OSD was evaluated. The aim of AMT was to achieve symptomatic relief, reduced inflammation, recurrence, and corneal haze; improve epithelization, stromal healing and visual acuity; and delay keratoplasty. Fresh amniotic membrane was used in all cases by a single surgeon. Follow-up and observations were done to evaluate success of achieving the goal.

Results: Indications for AMT included primary and recurrent pterygium, various types of corneal ulcers (non-healing ulcer, descemetocele, corneal thinning and perforation), spheroidal degenerations, chemical burn and bullous keratopathy. The aim of AMT was different in different etiological indications. Postoperative follow-up was between 6 and 18 months. Success and complication rate were observed. Symptomatic relief (reduced pain and redness) was seen in patients with various corneal ulcers, chemical burn and bullous keratopathy. Improved epithelialization and stromal healing was noted in corneal ulcer cases. In spheroidal degenerations, keratectomy with AMT improved vision. Recurrence of pterygium was low (4.61%); graft failure in the form of graft rejection was seen in only 3.07% cases of acute keratitis. Corneal vascularization (4.61%) was present but not severe enough to hamper vision. Success in gaining intended effect was the most significant result with AMT.

Conclusion: AMT in various ocular surface pathologies shows success in achieving the goal of symptomatic relief, improved epithelialization, stromal healing and vision. Reduction in inflammation, corneal haze and recurrence of original disease is achieved with minimum complications.

Keywords: Amniotic membrane transplantation; effective management; ocular surface disorders.

Figure 1

(a) Big non-healing corneal ulcer. (b) Big non-healing corneal ulcer after AMT. (c) Ulcer healed with corneal opacity

Figure 2

(a) Corneal thinning. (b) Corneal thinning, post multilayered AMT. (c) Multilayered AMT healing stage. (d) Multilayered AMT after healing with cataract

Figure 3

(a) Pterygium. (b) Postoperative pterygium with AMT and conjunctival autograft. (c) Pterygium follow-up

Figure 4

(a) Spheroidal degeneration. (b) Spheroidal degeneration after AMT. (c) Spheroidal degeneration: Follow-up; reduced corneal haze

Figure 5

(a) Chemical burn. (b) Chemical burn after AMT

Figure 6

(a) Corneal perforation. (b) Postoperative corneal perforation with air bubble in anterior chamber. (c) Corneal perforation after complete healing. (d) Anterior chamber formed in postoperative corneal perforation