Efficacious Application of Amniotic Membrane in the Surgical Management of Combined Mine-Explosive Corneal Injuries

Abstract

INTRODUCTION: Mine-explosive eye injuries, primarily affecting the cornea, occur due to several damaging factors from an explosive device. Several surgical methods stimulate corneal regeneration, including amnion transplantation, limbal stem cells from another healthy eye, induced pluripotent stem cells, mesenchymal stem cells, and bioprinting. Amniotic membrane transplantation prevents vascularization and fibrosis, improving reparative properties without causing transplant rejection, while the last three methods are still in clinical research stages. Our objective was to evaluate the results of the surgical strategy for addressing combined mine-explosive corneal injuries.
METHODS: A retrospective analysis of 22 cases (22 eyes) of military personnel with mine-explosive corneal injuries (22 men, aged 30-45 years) revealed promising outcomes. All patients were submitted to a first surgical approach to stabilize the cornea, and then: first group: secondary surgical intervention including amniotic bio coating followed by conservative measures; versus second group: secondary surgical intervention followed by conservative measures and delayed amniotic membrane transplantation. Treatment effectiveness was assessed by analyzing indicators such as corneal syndrome (photophobia, lacrimation, blepharospasm), corneal edema (biomicroscopy/OCT), neovascularization, and transplant rejection over a 3-month period (July to October 2023).
RESULTS: During the three-month observation period, neither group exhibited signs of transplant rejection or corneal neovascularization. Group I had a mean time to improvement of 3.64 ± 0.77 days, with a median of 4 days. Group II had a mean time to improvement of 6.55 ± 1.30 days, with a median of 7 days. Both groups showed positive dynamics in reducing corneal edema over three months. Group I demonstrated significant reduction in corneal thickness both at 1 month and at 3 months (by 18.56%). Group II also showed a reduction in corneal thickness, but less pronounced (by 5.88%). These results indicate a significantly faster and more pronounced decrease in corneal edema in Group I compared to Group II over the three-month period (t = 2.96, p = 0.008).
CONCLUSION: Managing mine-explosive corneal injuries presents formidable challenges. The concurrent implementation of surgical intervention and amniotic bio-coating exhibited notable efficacy, mitigating corneal syndrome, and decreasing corneal edema and inflammation, thus promoting corneal regeneration.