Amniotic membrane transplantation in ocular surface diseases

Prospective study including 23 eyes of 21 patients who underwent amniotic membrane transplantation at Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR) and at Cirurgia e Diagnose em Oftalmologia do Paraná (CDOP) clinic, located in Curitiba, PR, Brazil, from may 2015 to july 2019. The amniotic membrane was collected from elective and term cesarean delivery, and conserved in preservation medium and glycerol 1:1, stored at -80° Celsius. The membrane was fixed on the ocular surface with 10-0 nylon, 8-0 vicryl, biological glue or a combination of these materials.

Results:

The ocular surface reconstruction was successful in 22 eyes (95.6%). Failure was observed only in 1 case (bullous keratopathy) in which the condition was maintained postoperatively. Patients' age ranged from 11-82 years, with a mean age of 37.4 years. There was a higher incidence in males (66.6%). A difference was perceived in the distribution of the affected eye (which was greater in the right eye - 65.2%). As for the previous ophthalmic surgery history, 12 of the 23 eyes had a positive history (52.2%). It was observed that all patients who had preoperative visual acuity assessed showed improvement or maintenance of corrected visual acuity. In the postoperative period, complications associated with the underlying disease were observed, although not particularly related to the amniotic membrane transplantation. There were not any cases of postoperative infection.

Conclusions:

There was an improvement in the general state of the ocular surface in almost all of the cases in which the transplant was performed. Therefore, the amniotic membrane can be considered a good alternative for reconstructing the ocular surface, as a single or supporting treatment.

Keywords:
Amnion; Biological dressings; Transplantation; Eye injuries; Anterior eye segment

Diagnosis	Age	Sex	Affected eye	Preoperative	Postoperative
	(years)			CVA	CVA
Alkali burn	45	Female	Right	------	20/30
(Figures 1A, B)
Alkali burn	12	Male	Left	------	Hand Motion
Alkali burn	28	Male	Right	20/120	20/25
Alkali burn	44	Male	Right	Hand Motion	20/400
(Figures 2A,B)
Alkali burn	39	Male	Left	Hand Motion	Counting Fingers
Thermal burn	14	Female	Right	------	20/125
Shield ulcer	11	Male	Right	20/50	20/40
Shield ulcer	13	Male	Left	------	20/50
Shield ulcer	12	Male	Right	20/100	20/30
Perforated ulcer	82	Male	Right	------	20/100
Stevens-Johnson syndrome	28	Female	Both	------	20/20
20/20
Bullous keratopathy	47	Female	Right	Counting Fingers	Counting Fingers
Neurotrophic keratopathy	21	Female	Right	20/60	20/60
Neurotrophic keratopathy	34	Male	Right	Hand Motion	Hand Motion
Grade 4 recurrent pterygium	41	Male	Right	20/40	20/30
(Figures 3A,B)
Grade 4 recurrent pterygium	39	Male	Both	20/50	20/25
in right eye and grade 3 in left eye				20/25	20/25
Grade 3 recurrent pterygium	37	Female	Left	20/160	20/50
Epidermolysis bullosa	54	Male	Left	Counting Fingers	Counting Fingers
Ocular cicatricial pemphigoid	60	Male	Left	Hand Motion	Hand Motion
Symblepharon after excision of epidermoid carcinoma	72	Male	Right	Hand Motion	Counting Fingers
(Figures 4A, B)
Limbal deficiency	54	Female	Right	Counting Fingers	Counting Fingers

Postoperative complications	n(%)
Symblepharon	7 (33.3)
Corneal opacity	5 (23.8)
Conjunctivalization	5 (23.8)
Granuloma	3 (14.2)
Corneal thinning	2 (9.5)
Corneal neovessels	2 (9.5)
Trichiasis	1 (4.7)
Conjunctival sac shortening	1 (4.7)
Neurotrophic ulcer	1 (4.7)

Sociedade Brasileira de Oftalmologia Rua São Salvador, 107 , 22231-170 Rio de Janeiro - RJ - Brasil, Tel.: (55 21) 3235-9220, Fax: (55 21) 2205-2240 - Rio de Janeiro - RJ - Brazil
E-mail: rbo@sboportal.org.br

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[1] Autor correspondente: Nayara Teixeira Flügel. E-mail: dra.nayaraflugel@gmail.com