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Amniotic membrane transplant thwarts corneal ulceration after chemical, thermal trauma
Timely administration and sufficient fixation are necessary, according to study authors.
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Necrosis of the corneal limbus after chemical or thermal trauma causes corneal ulcerations that are often resistant to medical therapy. With prompt administration, amniotic membrane transplantation may thwart persistent corneal ulceration and aid epithelialization in patients with severe chemical and thermal eye trauma, according to a study.
“If used in time, and if amniotic membrane is safely secured, amniotic membrane transplantation (AMT) stops corneal ulceration in almost all cases,” study authors Oleksiy Buznyk, MD, PhD, and Stanislav Iakimenko, MD, PhD, DSc, said in an email interview.
Furthermore, AMT enables corneal healing in most patients, they said.
Results
In a retrospective review of 55 amniotic membrane transplantations in 53 patients, further corneal ulceration was prevented in 54 cases. Epithelialization occurred in 42 patients at a mean 24.2 days postoperatively. Corneal defect recurred in three patients.
Of the 53 patients, 39 had severe chemical injuries, 12 had severe thermal injuries and two had combined chemical-thermal injury at presentation.
In 15 of the 42 patients who experienced epithelialization, postoperative visual acuity improved two or more lines compared to preoperative values, and nine patients lost one line of acuity. No change was detected in the remaining patients.
The study was published in European Journal of Ophthalmology.
Repair
Methods of repair depend on the size of the corneal ulcer and necrotic area of conjunctiva. The most common method is to cover the entire ocular surface and posterior surface of the eyelids with an amniotic membrane patch, according to previously published studies. However, this method requires frequent reoperation, which can decrease patient comfort and compliance with the treatment.
Fixing the separated conjunctiva and Tenon’s capsule covering the edges of the fixated amniotic membrane (AM) graft prevents fast lysis of the AM and extends corneal healing, the authors said.
“We also use tarsorrhaphy to prevent conjunctiva and Tenon’s capsule retraction from the edges of the AM graft, thus preserving the graft from lysis,” Buznyk and Iakimenko said, adding that this fixation method results in a significantly decreased reoperation rate.
Timing
AMT is best performed when corneal ulceration is less than one-third corneal thickness, according to the authors.
In cases of severe trauma, in which corneal ulceration is combined with perilimbal conjunctival necrosis, the preferred method is to perform AMT in conjunction with conjunctival tenonplasty, the authors said. The combined operation can be implemented as soon as an apparent border of conjunctival necrosis appears, which is generally 2 to 3 weeks following severe injury.
It is not considered a complication when the AMT does not restore healthy corneal epithelium or prevent symblepharon formation in cases of severe trauma, the authors said, because the first goal of treatment is globe preservation.
“Operations to improve visual acuity and repair symblepharon can be started thereafter,” the authors said.
Buznyk and Iakimenko suggested that, rather than AMT, corneal grafting is the safer option for patients in whom a deep corneal ulcer has developed.
“We’re planning to study efficiency of our AMT method if it is used in earlier terms after the severe chemical or thermal injury to prevent possible corneal ulceration,” Buznyk and Iakimenko said. “Besides this study, we’re comparing AMT with conventional treatment of corneal ulceration after chemical or thermal injury.” – by Christi Fox
- Reference:
- Iakimenko SA, et al. Eur J Ophthalmol. 2013;doi:10.5301/ejo.5000243.
- For more information:
- Oleksiy Buznyk, MD, PhD, can be reached at the Department of Eye Burns, Ophthalmic Plastic Surgery, Keratoplasty and Keratoprosthesis, Filatov Institute of Eye Diseases and Tissue Therapy, Frantsuzkyi Boulevard 49/51, Odessa, Ukraine 65061; +380-48-748-15-78; email: a_buznik@bk.ru.
- Stanislav Iakimenko, MD, PhD, DSc, can be reached at the Department of Eye Burns, Ophthalmic Plastic Surgery, Keratoplasty and Keratoprosthesis, Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine, Frantsuzkyi Boulevard 49/51, Odessa, Ukraine 65061; +380-48-729-84-63; email: stanglory@gmail.com.
Disclosure: The authors have no relevant financial disclosures.