The Role of Bandage Contact Lenses Versus Amniotic Membrane in Corneal Wound Healing: A Systematic Review

Abstract

Corneal wound healing plays a vital role in restoring ocular surface integrity following injury or disease. Both bandage contact lenses (BCLs) and amniotic membranes (AM) are non-pharmacologic interventions widely used in ocular surface disease management. This systematic review focuses on presenting high-level clinical evidence supporting the effectiveness of bandage contact lenses versus amniotic membrane in corneal wound healing. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching five medical databases for relevant scholarly papers. The search was limited to studies published from January 2010 to March 2024. These databases included PUBMED, Medline, Web of Science, Google Scholar, and ScienceDirect. The study assessed clinical trials, randomized controlled trials, and prospective studies involving patients with corneal ulcers. It included studies that reported outcomes such as corneal opacity density, neovascularization, and the healing period of epithelial defects. Two independent, experienced researchers screened the extracted papers for potential inclusion, and in cases of disagreement, they engaged in discussions to resolve the issue. Relevant data were extracted from the selected studies using a structured data collection form. The Cochrane risk of bias assessment scale was used to evaluate the risk of bias in clinical trials and randomized controlled trials, while the Newcastle-Ottawa Quality Assessment Scale (NOS) was applied to assess prospective/retrospective, cross-sectional, and cohort studies. The results of the study indicate that BCLs and amniotic membrane transplantation (AMT) are safe and effective treatments for dry eye disease and corneal lesions. In cases of severe ulcerative keratitis and neurotrophic keratitis, AMT was shown to improve healing outcomes. AMT was also found to be more effective in treating deep stromal ulcers. Additionally, it enhances ocular integrity and promotes anatomical restoration following corneal perforation. Furthermore, AMT demonstrated significant efficacy in treating dry eye disease (DED). When combined with a bandage contact lens, dehydrated AMT was found to reduce symptoms of DED. However, its effectiveness remains limited in certain cases. The study also revealed that amniotic membrane suspension (AM suspension) serves as a non-invasive alternative to conventional AMT. In conclusion, AMT was more effective in managing deep stromal ulcers and neurotrophic keratitis, especially when retained for longer durations. Bandage contact lenses were useful in managing post-surgical epithelial defects and enhancing membrane retention. Future research should investigate long-term outcomes and combined therapy protocols.

Keywords: amniotic membrane; bandage contact lenses; corneal ulcer; epithelialization; wound healing.

Figure 1. PRISMA flow diagram illustrating study selection process.

Figure 2. Cochrane risk of bias assessment

Figure A shows the overall risk of bias summary across the included randomized controlled trials (RCTs). Figure B details study-specific assessments.