RESULTS AND INDICATIONS FOR AMNIOTIC MEMBRANE TRANSPLANTATION
H.E. Völcker, F.E. Kruse, K. Rohrschneider
The transplantation of preserved amniotic membrane (AMT) is becoming a valuable technique for reconstruction of the ocular surface. However there is only limited clinical experience with this novel technique so far. We therefore describe indications for AMT as well as our results during the first year of AMT for ocular surface reconstruction.
Methods: Amniotic membrane was prepared under cell culture conditions and frozen in 50% glycerin at -80C. During surgery the membrane was trimmed according to the desired size and fixed with 10-nylon to the cornea and with 8-0 vicryl or silk to the conjunctiva. Patients received a bandage lens after surgery and sutures were removed after 4 weeks. We performed AMT in 20 consequtive patients with 12 months followup.
Results: Indications for corneal surgery were persisting epithelial defects with steril ulceration e.g. due to neurotrophic origin or on corneal grafts. 12 patients showed stable reepithelialization and improved stromal thickness. However two of these patients had impaired epithelial healing which led to recurrent ulceration in one of them. In addition AMT allowed limbal reconstruction in 2 patients following surgery for limbal papilloma/CIN. Temporary reconstruction was possible following chemical burn and necrotic conjunctival defects. However two patients with recurrent pterygia experienced another recurrence following AMT.
Discussion: AMT is a valuable method for corneal reconstruction in the context of sterile corneal ulcers, limbal surgery and conjunctival defects. During surgery the patients epithelium has to be denuded underneath the amniotic membrane and the orientation of the membrane has to be guaranteed. Due to the easy mode of kryopreservation and the comfortable handling during surgery AMT is prooving to be a valuable addition to existing surgical tools for ocular surface reconstruction.
Augenklinik der Universität Heidelberg, INF 400, D-69120 Heidelberg