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Amniotic membrane a useful tool for every ophthalmologist
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British Journal of OphthalmologyA recent article by Tandon and colleagues in the described a study of 100 patients with moderate and severe ocular burns (both thermal and chemical) who were treated by conventional medical therapy with and without the adjunctive use of ocular surface transplantation with aminotic membrane (AMT). The study found that in patients in whom adjunctive amniotic membrane was applied as opposed to controls, epithelial healing time was substantially shortened. This is not surprising because AMT is routinely used to enhance epithelial healing in neurotrophic ulcers, diabetics with chronic epithelial defects and other ocular surface abnormalities.
What surprised me about the study was that the long-term outcome of these eyes was similar with and without AMT. However, the control and amniotic membrane groups were not equivalent, and I suspect that this skewed the study's results against the benefits of aminotic membrane. Eyes in the amniotic membrane group had significantly larger epithelial defects and more limbal conjunctival destruction. Additionally, both groups were made up of mostly children and young adults, who bear the best prognosis following ocular burns because of their healthy, robust conjunctiva. In the short term, children tend to heal quickly and well. If the treatment and control groups in this study had been equal, and if the patients had been followed for a longer time, it seems quite likely that the results would show more uncomplicated healing in the amniotic membrane-treated groups.
Amniotic membrane has a long history of use in ophthalmology, dating back to the 1930s. Although it is primarily used in the treatment of pterygium, it has received global acceptance as a useful tool in almost every type of ocular surface surgery. Besides speeding ocular healing, amniotic membrane quiets inflammation and allows restoration of a healthy ocular surface. I commend the authors of this study for bringing forth another data set showing the value of this most useful material.
- Financial Disclosure: Dr. Hovanesian is a consultant for Innovative Ophthalmic Products.
See Dr. Hovanesian share more expert insight live at Hawaiian Eye 2012, to be held January 15-20, 2012 at the Grand Wailea Resort & Spa in Wailea, Maui. Learn more at OSNHawaiianEye.com.