Ocular amniotic membrane transplantation clinical applications and outcomes

Abstract

Purpose: To assess the effectiveness of amniotic membrane transplantation (AMT) in severe ocular surface pathologies (OSP).

Introduction: The AMT is performed in severe OSP as support for proliferation of stem cells and for reepithelialisation of the cornea, permitting a return to anatomic integrity, a reduction in symptoms and an improvement in best corrected visual acuity (BCVA).

Methods: Retrospective analysis of 32 patients who underwent 37 AMT procedures between 2008-2017 at the Department of Ophthalmology of Hospital Espírito Santo de Évora for treatment of several OSP. Average age was 71.97 years (+-5.82). Grafts were applied through suture in 21 and fibrin glue in 16 cases. The average follow-up was 2.96 years (+-0.86). Failure, retransplantation, relapse, change in anatomic integrity, variation of symptoms and variation in BCVA rates were evaluated.

Results: 37 procedures were performed in 32 eyes, 9 failed, 3 of these were retransplanted and 3 relapsed. Failure was lower in corneal suture than fibrin glue (OR=0.278+-0.221, p =0.136). In 25 cases (78.13%, p<0.001) anatomic integrity was achieved. Regarding symptoms (p<0.01), 19 cases referred improvement, 8 cases no change and 5 cases worsening. Regarding BCVA, average change was irrelevant (p=0.587). In subgroup analysis, 10 cases registered an increase (average change of -0.50393, +- 0.51513 logMAR, p=0.0542), 19 cases remained stable and 3 cases progressed to a decrease (average change of +1.06804, +-1.00248 logMAR, p=0.0444).

Conclusions: AMT is, indeed, an effective and safe option when conservative treatment of OSP fails, being useful to return to anatomic integrity and to reduce OSP symptoms.

Keywords: Amniotic membrane transplantation, Ocular surface pathologies, Anatomic integrity, Best Corrected Visual Acuity, Fibrin Glue