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Amniotic membrane transplantation speeds healing of moderate ocular burns
Br J Ophthalmol. 2011;95:199-204.
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Amniotic membrane transplantation facilitated the healing of epithelial defects in patients with moderate-grade ocular burns, a study found.
"[Amniotic membrane transplantation] can be considered as a useful surgical option in moderate chemical burns with non-healing epithelial defects," the study authors said. "It may also be used judiciously in severe cases where close monitoring and follow-up are not possible and compliance with medication is not satisfactory."
The prospective, randomized clinical trial included 100 eyes of 100 patients: 50 patients with moderate, grade 2 or grade 3 burns and 50 patients with severe, grade 4 burns. Each severity group was randomized into study and control subgroups comprising 25 patients each. Average follow-up was 13.2 months.
Patients in the study groups underwent amniotic membrane transplantation in conjunction with conventional medical therapy. Controls underwent medical therapy alone, with mechanical release of adhesions if necessary.
Data showed a faster rate of epithelial healing in patients with moderate ocular burns who underwent amniotic membrane transplantation than in those who underwent standard therapy alone. The difference was statistically significant (P = .0004).
Average time for the epithelial defect to heal was 15 days in the study group and 21 days in the control group; the difference was not statistically significant.
Between-group differences in visual acuity, corneal clarity, vascularization and development of symblepharon were statistically insignificant.
Amniotic membrane transplantation appeared less effective in patients with severe ocular burns, the authors reported.
A study of moderate and severe chemical burns as large as this one published in BJO (100 patients) is indeed rare and worthy of attention. Clearly amniotic membrane transplantation (AMT) enhanced epithelial healing over conventional therapy alone. Long-term outcomes were the same with and without AMT, but AMT-treated eyes had significantly worse burns by several criteria. This study affirms the well-known anti-inflammatory and anti-cicatrizing properties of AMT in ocular surface surgery.
– John A. Hovanesian, MD
OSN
Cornea/External Disease Board Member
Disclosure: Dr. Hovanesian is a
consultant to Innovative Ophthalmic Products (IOP) Inc.