Amniotic membrane transplantation for ocular surface reconstruction: indications and outcomes.
BACKGROUND
The amniotic membrane is a useful tool in the management of several ocular surface diseases. Despite numerous studies, standardization of the use of the membrane and of outcome measures is lacking. Herein, the authors' results of amniotic membrane transplantation (AMT) in ocular surface reconstruction against defined outcome measures are reported.


METHODS
A retrospective case study of 74 consecutive procedures (58 patients) performed against predefined outcome measures. The cases were divided into three groups. Group A AMT in the presence of stem cell loss (32 procedures), Group B AMT without stem cell loss (24 procedures) and Group C AMT for conjunctival reconstruction (18 procedures). The outcomes were evaluated against defined criteria based on the purpose (patch or graft) and objective for use of the membrane. Results were analysed by defining the outcomes as success, partial success or failure.


RESULTS
Unequivocal success of the procedure was observed in 22% in Group A, 62.5% in Group B and 50% in Group C. AMT was significantly more successful in the presence of functioning stem cells (P = 0.01). In Group A acute and subacute cases (less than 3 months) needed more procedures compared with chronic cases (P = 0.02). In Group C, results were comparatively worse when AMT was used in progressive cicatrizing conditions.


CONCLUSIONS
Use of AMT can be associated with a significant number of failures. It provides a useful alternative for specific indications where its use should be encouraged. It is important to define criteria for success in order to accurately evaluate efficacy.
Maharajan
V Senthil
VS
Division of Ophthalmology and Visual Sciences, Eye, Ear, Nose and Throat Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
Shanmuganathan
Vijay
V
Currie
Alison
A
Hopkinson
Andrew
A
Powell-Richards
April
A
Dua
Harminder S
HS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000650:Amnion / Q000637:transplantation*; D002648:Child; D003229:Conjunctival Diseases / Q000175:diagnosis / Q000601:surgery*; D003316:Corneal Diseases / Q000175:diagnosis / Q000601:surgery*; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D015590:Fluorophotometry; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013234:Stem Cells / Q000473:pathology; D013536:Suture Techniques; D016896:Treatment Outcome