A MULTI-LAYER TECHNIQUE FOR AMNIOTIC MEMBRANE TRANSPLANTATION
F.E. Kruse, K. Rohrschneider, H.E. Völcker
The transplantation of preserved amniotic membrane (AMT) is becoming a valuable technique for reconstruction of the ocular surface. However single layer transplantation is often insufficient for deep stromal ulcers and results in incomplete epithelialization. We therefore describe our experience with a multilayer approach for AMT.
Method: 12 consecutive patients with deep corneal ulcers (including three descemetoceles) have been treated with AMT. Following careful removal of the corneal epithelium the defect was filled with concentric pieces of amniotic membrane up to the level of healthy Bowmans membrane. The total area was then covered with one larger membrane. Patients received a bandage lens for up to 4 weeks when sutures were removed.
Results: In 10 eyes reepithelialization of the membrane was complete after up to four weeks and remained stable ever since (10 ± 4 months). The subepithelial membrane deminished in size and partially remained visible for up to 12 months. One patient with descemetocele showed incomplete epithelialization and recurrent stromal ulceration. A second patient with additional dry eye suffered from an epithelial defect 2 months after the epithelium had been closed. He could be treated with a bandage lens.
Discussion: The transplantation of several layers of amniotic membrane is suitable for the reconstruction of deep corneal ulcers up to the level of Descemet s membrane. To ensure success both rapid and complete reepithelialization are necessary. Once epithelialized, amniotic membrane seems to be substituted by corneal stroma.
Augenklinik der Universität Heidelberg, INF 400, D-69120 Heidelberg