J Korean Ophthalmol Soc.  2007 Aug;48(8):1036-1040.

The Efficacy of Amniotic Membrane Graft in the Treatment of Symptomatic Bullous Keratopathy

• Park JH
• Jeoung JW
• Wee WR
• Lee JH
• Kim MK
• Lee JL

Abstract

PURPOSE: To evaluate the efficacy of amniotic membrane (AM) transplantation in symptomatic bullous keratopathy using cryo-preserved or lyophilized AM.
METHODS
Eight bullous keratopathic patients, who experienced intractable pain despite medication and the application of a therapeutic lens, underwent permanent AM transplantation with 5 cryo-preserved and 3 lyophilized AMs following removal of epithelium using a trephine. The time to re-epithelization and the subsidence of pain were evaluated retrospectively.
RESULTS
Mean follow-up was 252+/-171.0 days. Pain relief and re-epithelization were obtained in all eight patients. The times to complete relief of pain was 32.2+/-22.7 days in patients with cryo-preserved AM transplantations (n=5) and 22.0+/-18.0 days in those with lyophilized AM transplantations (n=3) (p=0.549, Mann-Whitney U test). Respective times to re-epithelization were 25.4+/-20.7 days and 23.0+/-25.2 days (p=0.297). There were no significant differences in the diameter of transplanted AMs between the two groups (7.6+/-0.2 vs. 7.3+/-0.3 mm, p=0.172).
CONCLUSIONS
Permanent AM transplantation effectively reduced the intractable pain caused by epithelial bulla. Whether the AM was cryo-preserved or lyophilized did not affect the efficacy of the treatment.

Keyword

Amniotic membrane transplantation; Bullous keratophathy; Epithelization; Preservation

MeSH Terms

Amnion*
Epithelium
Follow-Up Studies
Humans
Pain, Intractable
Retrospective Studies
Transplants*

Figure

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  Figure 1. A 44 year-old man with diffuse corneal edema and bulla with intractable pain 10 years after cataract extraction and ACL insertion (A). A day after ACL removal, superficial keratectomy and permanent AMT (B). At two months after the operation, the bulla resolved and he had no pain (C).

Reference

References

1. de Rotth A. Plastic repair of conjunctival defects with fetal membrane. Arch Ophthalmol. 1940; 23:522–5.

2. Kim JC, Tseng SC. Transplantation of preserved human amniotic membrane for surface reconstruction in severely damaged rabbit corneas. Cornea. 1995; 14:473–84.

3. Grueterich M, Espana EM, Tseng SC. Ex vivo expansion of limbal epithelial stem cells: amniotic membrane serving as a stem cell niche. Surv Ophthalmol. 2003; 48:631–46.

4. Prabhasawat P, Tesavibul N, Komolsuradej W. Single and multilayer amniotic membrane transplantation for persistent corneal epithelial defect with and without stromal thinning and perforation. Br J Ophthalmol. 2001; 85:1455–63.

5. Shin KS, Chung IY, Seo SW. The Effect of Amniotic Membrane Trans plantation for Corneal Ulcerand Ocular Surface Diseases J Korean Ophthalmol Soc. 2003; 44:1305–10.

6. Tseng SC, Prabhasawat P, Lee SH. Amniotic membrane transplantation for conjunctival surface reconstruction. Am J Ophthalmol. 1997; 124:765–74.

7. Tamhane A, Vajpayee RB, Biswas NR, et al. Evaluation of amniotic membrane transplantation as an adjunct to medical therapy as compared with medical therapy alone in acute ocular burns. Ophthalmology. 2005; 112:1963–9.

8. Meller D, Pires RT, Mack RJ, et al. Amniotic membrane transplantation for acute chemical or thermal burns. Ophthalmology. 2000; 107:980–9.

9. Tseng SC, Prabhasawat P, Barton K, et al. Amniotic membrane transplantation with or without limbal allografts for corneal surface reconstruction in patients with limbal stem cell deficiency. Arch Ophthalmol. 1998; 116:431–41.

10. Ucakhan OO, Koklu G, Firat E. Nonpreserved human amniotic membrane transplantation in acute and chronic chemical eye injuries. Cornea. 2002; 21:169–72.

11. Hanada K, Shimazaki J, Shimmura S, et al. Multi layered amniotic membrane transplantation for severe ulceration of the cornea and sclera. Am J Ophthalmol. 2001; 131:324–31.

12. Jeoung JW, Yoon YM, Lee JL, et al. The Effect of Amniotic Membrane Transplantation on the Treatment of Necrotizing Scleritis after Pterygium Excision. J Korean Ophthalmol Soc. 2004; 45:1981–8.

13. Pires RTF, Tesng SCG, Prabhasawat P, et al. Amniotic membrane transplantation for symptomatic bullous keratopathy. Arch Ophthalmol. 1999; 117:1291–7.

14. Espana EM, Crueterich M, Sandoval H, et al. Amniotic membrane transplantation for bullous keratopathy in eyes with poor visual potential. J Cataract Refract Surg. 2003; 29:279–84.

15. Nakamura T, Yoshitani M, Rigby H, et al. Sterilized, Freeze-Dried Amniotic Membrane: A Useful Substrate for Ocular Surface Reconstruction Invest Ophthalmol Vis Sci. 2004; 45:93–9.

16. Grueterich M, Espana EM, Tseng SC. Modulation of keratin and connexin expression in limbal epithelium expanded on denuded amniotic membrane with and without a 3T3 fibroblast feeder layer. Invest Ophthalmol Vis Sci. 2003; 44:4230–6.

17. Koizumi N, Rigby H, Fullwood NJ, et al. Comparison of intact and denuded amniotic membrane as a substrate for cell-suspension culture of human limbal epithelial cells. Graefes Arch Clin Exp Ophthalmol. 2007; 245:123–34.

18. Nakamura T, Inatomi T, Sekiyama E, et al. Novel clinical application of sterilized, freeze-dried amniotic membrane to treat patients with pterygium. Acta Ophthalmol Scand. 2006; 84:401–5.

19. Anderson DF, Prabhasawat P, Alfonso E, et al. Amniotic membrane transplantation after the primary surgical management of band keratopathy. Cornea. 2001; 20:354–61.

20. Choi YS, Kim JY, Wee WR, Lee JH. Effect of application of human amniotic membrane on rabbit corneal wound healing after excimer laser photorefractive keratectomy. Cornea. 1998; 17:389–95.

21. Woo HM, Kim HS, Kweon OK, et al. Effects of amniotic membrane on epithelial wound healing and stromal remodeling after excimer laser keratectomy in rabbit cornea. Br J Ophthalmol. 2001; 85:345–9.

22. Paridaens D, Beekhuis H, Vanden Bosch W, et al. Amniotic membrane transplantation in the management of conjunctival malignant melanoma and primary acquired melanosis with atypia. Br J Ophthalmol. 2001; 85:658–61.

23. Espana EM, Prabhasawat P, Grueterich M, et al. Amniotic membrane transplantation for reconstruction after excision of large ocular surface neoplasias. Br J Ophthalmol. 2002; 86:640–5.

24. Ti SE, Tseng SC. Management of primary and recurrent pterygium using amniotic membrane transplantation. Curr Opin Ophthalmol. 2002; 13:204–12.

25. Shimazaki J, Kosaka K, Shimmura S, Tsubota K. Amniotic membrane transplantation with conjunctival autograft for recurrent pterygium. Ophthalmology. 2003; 110:119–24.

26. Jain S, Rastogi A. Evaluation of the outcome of amniotic membrane transplantation for ocular surface reconstruction in symblepharon. Eye. 2004; 18:1251–7.

27. Mekia LF, Santamaria JL, Acosta C. Symptomatic management of postoperative bullous keratopathy with nonpreserved human amniotic membrane. Cornea. 2002; 21:342–5.

28. Tang GG, Ahn HB, Park WC. The Clinical Effects of Dye-Amniotic Membrane Transplantation on Bullous Keratopathy. J Korean Ophthalmol Soc. 2003; 44:1741–7.

29. Grueterich M, Espana EM, Tseng SC. Ex vivo expansion of limbal epithelial stem cells: amniotic membrane serving as a stem cell niche. Surv Ophthalmol. 2003; 48:631–46.