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Review
. 2020 Mar 4;10(1):13-21.
doi: 10.4103/tjo.tjo_5_20. eCollection 2020 Jan-Mar.

Amniotic membrane transplantation for managing dry eye and neurotrophic keratitis

Olivia G Mead  1 , Sean Tighe  1   2   3 , Scheffer C G Tseng  1   4
Affiliations
Review

Amniotic membrane transplantation for managing dry eye and neurotrophic keratitis

Olivia G Mead et al. Taiwan J Ophthalmol. .

Abstract

Neurotrophic keratitis (NK), a degenerative disease caused by damage to the trigeminal nerve, abolishes both tearing and blinking reflexes, thus causing the most severe forms of dry eye disease (DED). Conversely, the increasing severity of DED also leads to progressive loss of corneal nerve density, potentially resulting in NK. Both diseases manifest the same spectrum of corneal pathologies including inflammation and corneal epithelial keratitis, which can progress into vision-threatening epithelial defect and stromal ulceration. This review summarizes the current literature regarding outcomes following sutured and sutureless cryopreserved amniotic membrane (AM) in treating DED as well as epithelial defects and corneal ulcers due to underlying NK. These studies collectively support the safety and effectiveness of cryopreserved AM in restoring corneal epithelial health, improving visual acuity in eyes with NK and DED, and alleviating symptomatic DED. Future randomized controlled trials are warranted to validate the above findings and determine whether such clinical efficacy lies in promoting corneal nerve regeneration.

Keywords: Amniotic membrane; corneal ulcer; dry eye; epithelial defect; neurotrophic keratitis.

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Conflict of interest statement

OM, ST, and ST are employees of TissueTech. Dr Tseng has obtained a patent for the method of preparation and clinical uses of amniotic membrane and has licensed the rights to TissueTech, Inc, which procures and processes, and to Bio-Tissue, Inc, which is a subsidiary of TissueTech, Inc, to distribute cryopreserved amniotic membrane for clinical and research uses.

Figures

Figure 1
Figure 1
Neuroanatomic integration to maintain ocular surface health. Ocular surface health is maintained by a stable tear film, which comprises both compositional and hydrodynamic components. The former includes ocular surface epithelium producing mucins, meibomian glands producing meibum, and lacrimal glands producing aqueous tears. The latter includes eyelids, which blink at appropriate frequencies to enable tear distribution, tear clearance, and eye closure to prevent evaporation. The compositional factors are controlled by the tearing (compositional) reflex, whereas the hydrodynamic factors are controlled by the blinking (hydrodynamic) reflex. Both the tearing reflex and blinking reflex are stimulated by sensory input from the first (ophthalmic) branch of the trigeminal nerve, with output mediated by the parasympathetic and the motor branch of the facial nerve, respectively
Figure 2
Figure 2
The overlap between neurotrophic keratitis and dry eye disease pathologies. NK results in corneal epithelial keratitis (neurotrophic keratitis 1), epithelial defect (neurotrophic keratitis 2), and stromal ulcer (neurotrophic keratitis 3). These corneal pathologies are also observed in moderate-to-severe dry eye disease, graded as DEWS 2–4. The tear film breaks up into dry spots as evidenced by fluorescein staining in mild dry eye disease or DEWS 1
See this image and copyright information in PMC

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