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Current Ophthalmology
Virender S. Sangwan, MS; Sanghamitra Burman, MD, FRCS; Sushma Tejwani, DO;
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Amniotic membrane transplantation is currently being used for a continuously widening spectrum of
ophthalmic indications. It has gained widespread attention as an eective method of reconstruction of the
ocular surface. Amniotic membrane has a unique combination of properties, including the facilitation of
migration of epithelial cells, the reinforcement of basal cellular adhesion and the encouragement of epithelial
dierentiation. Its ability to modulate stromal scarring and its anti-inammatory activity has led to its use in
the treatment of ocular surface pathology as well as an adjunct to limbal stem cell grafts. Amniotic membrane
transplantation has been used for reconstruction of the corneal surface in the setting of persistent epithelial
defects, partial limbal stem cell deciency, bullous keratopathy and corneoscleral ulcers. It has also been used
in conjunction with limbal stem cell transplantation for total limbal stem cell deciency. Amniotic membrane
grafts have been eectively used as a conjunctival substitute for reconstruction of conjunctival defects
following removal of pterygia, conjunctival lesions and symblephara. More recently, amniotic membrane has
been used as a substrate for ex vivo cultivation of limbal, corneal and conjunctival epithelial cells. This article
reviews the current literature on the applications of amniotic membrane transplantation and its outcome in
various ophthalmic conditions.
Key words: Amniotic membrane graft, ocular surface disorders
Indian J Ophthalmol 2007;55:251-60
Th
Epithelial monolayer
Thick basement membrane
Avascular, hypocellular stromal matrix
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INDIAN JOURNAL OF OPHTHALMOLOGY
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Principles of surgery
The main objectives of AMT are ocular surface reconstruction,
promotion of epithelialization, providing symptomatic relief
and reducing inammation. There are three basic principles
upon which the nal technique is individualized.
Surgical Technique
Corneal surface reconstruction
Non-absorbable sutures are used to anchor AMGs to the
cornea. A single sheet of AM may be applied as an inlay graft
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Sangwan et al. Amniotic membrane transplantation
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Symblepharon release
Fornix formation
Socket reconstruction
Conjunctivochalasis
Entropion correction
Corneal surface reconstruction
PEDs
Non-healing stromal ulcers
Partial LSCD
Total LSCD
Bullous keratopathy
Band keratopathy
Scleral melt
Substrate for ex vivo expansion of limbal stem cells
Th
Outcome of AMT
Cicatrizing conjunctivitis
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Multilayered
AMG
After AMG
10-0 sutures
AMG
AMG
Symblepharon
Perilimbal sutures
Th
8-0 vicryl
sutures
AMG
10-0 nylon
sutures
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Sangwan et al. Amniotic membrane transplantation
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PED
PED signify varying degrees of LSCD and chronic inammation.
AM serves to provide a basement membrane substrate for the
migration and adhesion of epithelial cells when used as an
Figure 9: Clear visual axis with inferior pannus, two months following
amniotic membrane transplantation
Figure 11: Bulbar conjunctiva three months after excision of the mass
with amniotic membrane transplantation showing a corneal surface that
healed with minimal scarring
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Postop
Perilimbal
sutures
AMG
Th
8-0 vicryl
suture
10-0 nylon
sutures
AMG
CLAG
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Sangwan et al. Amniotic membrane transplantation
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Postoperative management
A broad-spectrum topical antibiotic is used for one to two
weeks initially, until the epithelium heals. Topical steroids
are used for six to eight weeks in tapering doses to reduce
surface inammation. Systemic immunosuppression is not
required.64
Complications of AMT
In the immediate postoperative period one may come across
hematoma formation under the membrane.65 The blood usually
absorbs or may need drainage, by making a small opening in
the graft, if excessive. Premature degradation of the membrane
and cheese wiring may need frequent repeat transplantations.
Occasionally, a residual subepithelial membrane may persist in
some cases and inadvertently opacify the visual axis.
Conclusion
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