J Korean Ophthalmol Soc.  2012 Jan;53(1):27-36. 10.3341/jkos.2012.53.1.27.

Efficacy of the Sutureless Amniotic Membrane Patch for the Treatment of Ocular Surface Disorders

• Yang J
• Sim HC
• Park DJ

• KMID: 2215242
• DOI: http://doi.org/10.3341/jkos.2012.53.1.27

Abstract

PURPOSE
To evaluate the efficacy of the sutureless amniotic membrane (AM) patch for the treatment of ocular surface disorders.
METHODS
A sutureless AM patch using a silicone ring was utilized to treat neurotrophic ulcer, persistent epithelial defect (PED), Shield ulcer, chemical injury and Stevens-Johnson syndrome. Primary outcome was the time to complete corneal and conjunctival epithelialization. Secondary outcome was the number of repeated insertions and complications of the inserted ring.
RESULTS
Neurotrophic ulcer was observed in 4 eyes, PED in 2 eyes, Shield ulcer in 1 eye, chemical injury in 4 eyes and Stevens-Johnson syndrome in 4 eyes. The mean (SD) time to complete epithelialization was 13 (7.2) days (6-20 days) in neurotrophic ulcer, 17.5 (7.7) days (12-23) in PED, 5 days in Shield ulcer, 10.6 (6.6) days (3-15) in chemical injury and 13.5 (0.7) days (13-14) in Stevens-Johnson syndrome. There were no protrusion or mechanical trauma of the inserted ring. In 1 case of neurotrophic ulcer and 1 refractory case of chemical injury, repeated insertion was performed due to incomplete healing after dissolution of the AM. In 2 eyes with Stevens-Johnson syndrome, repeated insertion was necessary with heavy accumulation of inflammatory debris on the AM. No symblepharon or fornix contracture was found in chemical injury or Stevens-Johnson syndrome patients.
CONCLUSIONS
The sutureless AM patch using a silicone ring was shown to be effective and safe for the treatment of ocular surface disorders. The patch can help surgeons avoid suture-related trauma to the ocular surface during the acute inflammatory period.

Keyword

Epithelialization; Ocular surface disorders; Silicone ring; Sutureless amniotic membrane patch

MeSH Terms

Amnion
Contracture
Eye
Silicones
Stevens-Johnson Syndrome
Ulcer
Silicones

Figure

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  Figure 1 Surgical amniotic membrane transplantation for Stevens-Johnson syndrome requires lots of sutures (A) and bolster suture (B) that may irritate the ocular surface even worse.

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  Figure 2 The structure of the 2 types of amniotic membrane fixation silicone ring: round (A) and oval (B).

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  Figure 3 The selected silicone ring (either round or oval) is placed on the amniotic membrane (AM) (A) and wrapped up with the AM carefully peeled off the nitrocellulose paper from one end to the other (B, C, D, E). The AM is fixed on the silicone ring with 10-0 nylon and the completed AM fixation silicone ring (F) is ready to be placed in the patient's eye right away.

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  Figure 4 Silicone ring fixed with amniotic membrane patch is inserted deep into the fornix (A). Its various sizes and flexibility makes it easy to fit in small eyes as well. The amniotic membrane is expanded and closely adhered to the ocular surface due to its elasticity (B).

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  Figure 5 The amniotic membrane fixation silicone ring is well placed in the fornix and the amniotic membrane (AM, white short arrows) is adhered closely to the ocular surface (patient 8) confirmed by the anterior segment optical coherence tomography (Visante OCT; Carl Zeiss Meditec, Dublin, CA). Notice the hole on the silicone ring for easy suture on fixing the AM on the ring.

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  Figure 6 Outcomes of non-surgical amniotic membrane patch using round silicone ring. Patient 3, neurotrophic ulcer patient with corneal epithelial defect and opacity (A). Round AM ring was inserted (B) and additional AM ring was exchanged due to dissolution of AM before complete epithelialization. Epithelial defect was healed 19 days after the first insertion (C, D). Patient 5, PED patient (previous visual loss due to diabetic retinopathy) with corneal epithelial defect (E) (with fluorescein staining [F]) showed marked reepithelialization after insertion of AM ring (G) and closure of epithelial defect after 12 days (H). Patient 7, Shield ulcer patient with corneal epithelial defect (I, J). Round AM ring was inserted (K) and epithelium was healed in 5 days (L).

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  Figure 7 Outcomes of non-surgical amniotic membrane patch using oval silicone ring. Patient 9, chemical injury patient with extensive corneal and conjunctival epithelial defects (A) showed healing of the defects after insertion (B, C) and smooth and stable ocular surface 3 days later (D). Patient 12, Stevens-Johnson syndrome patient with surface defects and corneal opacity showed improvement 13 days after insertion (E) and a stable surface with faint corneal opacity (F).

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  Figure 8 Comparison of ProKera® (left) and silicone ring for amniotic membrane (AM) fixation (right). AM ring is entirely covered with amniotic membrane that can adhere to the entire ocular surface and its flexibility reduces discomfort.

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  Figure 9 The oval ring can adhere to not only the bulbar conjunctiva but the palpebral conjunctiva that maintains the fornix and prevents symblepharon.

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