Indications for Amniotic Membrane Graft

Abstract

Abstract: : Purpose: To define the suitable indications for amniotic membrane graft (AMG). Methods: The records of 57 patients (57 eyes) who underwent amniotic membrane graft from September 2000 to November 2002 were reviewed. Patients were divided into 3 groups depending on the desired effect obtained: 1) pain relief achievement (14/57 eyes), 2) epithelial and stromal healing promotion (40/57 eyes), 3) conjunctival reconstruction (3/57 eyes). Causes of pain in group 1, were related to bullous keratopathy (5/14 eyes), band keratopathy (7/14 eyes), sterile melting after Acanthamoeba keratitis (1/14 eye) and persistent epithelial defect after PRK (1/14 eye). In group 2, 6/40 eyes were postherpetic ulcers, 5/40 neurotrophic ulcers, 8/40 toxic ulcers, 7/40 immune mediated ulcers and melting, 14/40 mild to moderate limbal stem cell deficiency secondary to chemical or thermal burns. Group 3 included patients with symblepharon due to graft-versus-host disease (1 eye) and secondary to chemical burn (2 eyes). Results: Group 1: pain relief was achieved in 13/14 patients within 2 days after surgery; in 1 case the graft failed and the patient necessitated a conjunctival flap. Group 2: amniotic membrane graft was successful in 33/40 eyes; 6/40 eyes (3 chemical burns, 1 postherpetic ulcer, 1 toxic ulcer, 1 ocular cicatricial pemphigoid) needed a new graft. The graft was performed 5 times in one patient with ocular cicatricial pemphigoid with severe corneal thinning. Amniotic membrane was totally integrated with the cornea in 3/40 eyes and in 37/40 totally dissolved within 26 days (7-45). Group 3: the amniotic membrane allowed a successful reconstruction of the fornices in the 2 eyes with chemical burn, while the graft partially failed to reconstruct conjunctival fornices in the patient with graft-versus-host disease. Conclusions: Amniotic membrane graft can be used successfully to relief pain and to reduce inflammation of the ocular surface; it can be used to promote epithelial and stromal healing and also to reconstruct the conjunctiva in case of symblefaron.

Keywords: cornea: clinical science • inflammation • keratitis