Abstract:
Introduction: The human amniotic membrane (HAM) has been proved to possess a multitude of
beneficial effects - stimulation of epithelialization, antiangiogenic, antibacterial and antiinflamatory
effects, which can be very useful in many ophthalmological indications, such as corneal trophic
ulcers resistant to medication and some cases of ocular surface destruction. Besides evaluating the
efficiency of the HAM transplantation in this paper, we tried to describe our experience with
amniotic membrane in the treatment of ocular surface abnormalities.
Purpose and objectives: To introduce the HAM transplantation indications in ophtalmology, to
present the methods an techniques of HAM aplication on the human eye, to describe our experience
with the amniotic membrane and to analyse the transplantation outcomes in patients with corneal
ulcers of diverse etiology.
Materials and methods:19 patients were included in the study. All of them underwent HAM
transplantation from December 2014 to March 2015, at the MCH „St. Trinity”. The patients
presented corneal ulcers of diverse complexity and etiology and were distributed in 3 main
categories: group A (n=14), which included patients with corneal erosions in dry eye syndrome
(n=5), viral keratitis (n=6), persistent epithelial defects after corneal abscess (n=2) and chemical
burns (n=1); group B (n=4), which included patients with severe stromal thinning and iminent
corneal perforation; group C (n=1), with one case of symblepharon and extensive corneoconjunctival
adhesions. The HAM was prepared from a fresh placenta of a seronegative pregnant
woman and stored at -80°C. In all cases the amniotic membrane was applied on the ocular surface
using the „patch” technique only.
Results: The cornea regenerated satisfactory in 11 patients out of 14 in group A, but the epithelial
defect recurred in 3 of these cases. In the second group the transplantation was less effective - 2
patients out of 4 needed further tectonic corneal graft and 1 penetrant keratoplasty was performed.
The HAM transplantation showed good results in symblepharon surgery, facilitating
epithelialization and preventing corneo-conjunctival adhesions in the group C.
Conclusions: The HAM transplantation proved efficient in facilitating corneal healing and
regeneration in patients with persistent epithelial defects, as well as preventing corneo-conjunctival
adhesions following symblepharon surgery. Nevertheless, in some cases, further surgery was
needed for ocular surface reconstruction. The HAM transplantation wasn’t effective enough to
prevent the tectonic corneal graft if severe stromal thinning and impending corneal perforation
were involved.
