Clinical Uses of Human Amniotic Membrane for Ocular Surface Diseases

Abstract

This study evaluated the clinical efficacy of amniotic membrane transplantation with or without limbal graft in the management of ocular surface disease (11 primary pterygia, nine recurrent pterygia, one limbal choristoma, three chemical injuries, and one cryotherapy to the limbal region). In addition, eight patients underwent the temporary amniotic membrane anchoring flap surgery for two, chronic stromal herpetic keratitis, two non-healing corneal ulcer. two corneal perforation, and two chemical bums. The average duration of follow-up ranged from 3 to 40 months (mean 24.3 +/- 10.4 months). In pterygium, the recurrence rate was 18% (2/11) after amniotic membrane transplantation. In recurrent pterygium and pseudopterygium, amniotic membrane transplantation with a small piece of limbal autograft resulted in an improved ocular surface without recurrence in all of the cases, and symblepharon and ocular motility were significantly improved postoperatively. Complications included submembrane hemorrhage (12%, 3/25) and early detachment or dissolution of the membrane (4%, 1/25). No major complications such as infection and rejection were encountered. In selected cases, a temporary amniotic membrane flap anchored onto the corneal surface led to rapid epithelial wound healing in unresponsive ulcerative keratitis. These results indicate that extracellular matrix components provide a good cell basement membrane interaction that is critical for cytoskeletal changes or differentiation. Furthermore, the amniotic membrane can also protect the ocular surface from being exposed to the unwanted inflammatory cytokines, derived fi om tears, and subconjunctival inflammatory cells. These procedures are thought to be clinically useful for ocular surface reconstruction.