title: Intraoperative Fluorescein Staining of Cryopreserved Amniotic Membrane Grafts to Improve Visualization During and After Pterygium Surgery: A Novel Technique.
abstract: OBJECTIVE
  To describe a new method of enhancing the visualization of amniotic membrane grafts with fluorescein staining during pterygium surgery.
  
  
  METHODS
  Pterygium excision surgery using intraoperatively stained cryopreserved amniotic membranes was performed on 346 eyes. A sterile 0.6 mg sodium fluorescein strip was placed directly onto the amniotic membrane in the manufacturer's original packaging, and the stained allograft was then transplanted onto the planned site. Staining intensities, at 3, 5, and 10 minutes of dye immersion, were compared. Immediate postoperative pain rating (scale 0-10), visibility of the fluorescein-stained amniotic membrane graft, and conjunctival autograft and amniotic membrane graft elevation, dehiscence, retraction, or displacement were recorded. The recurrence rate of the study population was compared with that of a previous cohort of 121 patients who underwent pterygium excision with conjunctival autograft without stained amniotic membrane.
  
  
  RESULTS
  Direct contact of the fluorescein strip on the amniotic membrane at 3, 5, and 10 minutes showed no differences in subjective staining intensity. Fluorescein-stained amniotic membrane was easily detected on the ocular surface during and 24 hours after pterygium surgery. The average immediate postoperative pain rating was 0.8 ± 1.8. No intraoperative complications or postoperative amniotic membrane graft dehiscence, retraction, or displacement occurred. The recurrence rate using fluorescein-stained amniotic membrane (3 patients, 0.9%, mean follow-up time 31.8 ± 18.6 weeks) did not differ from that of the previous cohort without the stained amniotic membrane (2.5%; χ(1) = 1.837, P = 0.183).
  
  
  CONCLUSIONS
  Fluorescein strip staining of the amniotic membrane is a novel and safe intraoperative method to enhance visualization and handling of the graft during and after ocular surgeries.
authors.affiliation: *Department of Research, Visionary Eye Doctors, Rockville, MD; †Department of Ophthalmology, Medstar Georgetown University Hospital, Washington, DC; and ‡Department of Ophthalmology, Medstar Washington Hospital Center, Washington, DC.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ha
authors.forename: J Alberto
authors.initials: JA
authors.lastname: Martinez
authors.forename: Michael
authors.initials: M
authors.lastname: Korchak
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Cremers
mesh_terms: D000328:Adult; D000650:Amnion / Q000637:transplantation*; D005260:Female; D019793:Fluorescein / Q000008:administration & dosage*; D005456:Fluorescent Dyes / Q000008:administration & dosage*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D011625:Pterygium / Q000601:surgery*; D012189:Retrospective Studies
chemical_list: D005456:Fluorescent Dyes; D019793:Fluorescein