Novel sutureless transplantation of bioadhesive-coated, freeze-dried amniotic membrane for ocular surface reconstruction.
OBJECTIVE
To evaluate the efficacy and safety of a novel sutureless transplantation of bioadhesive-coated, sterilized, freeze-dried amniotic membrane (FD-AM) for ocular surface reconstruction.


METHODS
A bioadhesive-coated, freeze-dried amniotic membrane was made by freeze drying the denuded AM in a vacuum, applying the minimum amount of fibrin glue (mixture of fibrinogen and thrombin) necessary to retain adhesion on the chorionic side, and sterilizing it by gamma-radiation. The resultant AM was characterized for its biological and morphologic properties by immunohistochemical and electron microscopic examination. In addition, fibrin glue-coated, freeze-dried (FCFD) AM was transplanted onto a rabbit scleral surface without sutures, to examine its biocompatibility.


RESULTS
Immunohistochemistry of the FCFD-AM revealed that fibrinogen existed on its chorionic side, and the process of applying fibrin glue did not affect its biological and morphologic properties. Moreover, electron microscopic examination of the chorionic side of the FCFD-AM revealed tiny microfibrils (which are probably fibrinogen protofibrils), and showed that the epithelial surface of FCFD-AM consisted of intact basal lamina similar to that of FD-AM. FCFD-AM transplantation was very easily performed, and the graft adhered to the bare sclera immediately. Though the fibrinogen naturally biodegraded within 2 weeks, the FCFD-AM remained for at least 12 weeks after transplantation. Epithelialization on the FCFD-AM was achieved within 2 weeks, as was the case with FD-AM transplantation. The conjunctival epithelium on the FCFD-AM was well stratified and not keratinized, suggesting that FCFD-AM supports normal cell differentiation.


CONCLUSIONS
The FCFD-AM retained most of the biological characteristics of FD-AM. Consequently, this sutureless method of transplantation of FCFD-AM is safe, simple, and useful for ocular surface reconstruction.
Sekiyama
Eiichi
E
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Graduate School of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-0841, Japan.
Nakamura
Takahiro
T
Kurihara
Eiji
E
Cooper
Leanne J
LJ
Fullwood
Nigel J
NJ
Takaoka
Maho
M
Hamuro
Junji
J
Kinoshita
Shigeru
S
D000650:Amnion / Q000378:metabolism / Q000637:transplantation* / Q000648:ultrastructure; D000818:Animals; D002454:Cell Differentiation; D020099:Coated Materials, Biocompatible; D003890:Desiccation; D004847:Epithelial Cells / Q000166:cytology / Q000378:metabolism; D016326:Extracellular Matrix Proteins / Q000378:metabolism; D015718:Fibrin Tissue Adhesive; D005340:Fibrinogen / Q000378:metabolism; D019084:Fluorescent Antibody Technique, Indirect; D005612:Freeze Drying; D006801:Humans; D008422:Materials Testing; D008855:Microscopy, Electron, Scanning; D011817:Rabbits; D019651:Plastic Surgery Procedures; D012590:Sclera / Q000601:surgery*; D013536:Suture Techniques; D014014:Tissue Adhesives
D020099:Coated Materials, Biocompatible; D016326:Extracellular Matrix Proteins; D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives; D005340:Fibrinogen