International Ophthalmology

, Volume 34, Issue 3, pp 485–491 | Cite as

Role of multilayered amniotic membrane transplantation for the treatment of resistant corneal ulcers in North India

  • Shalini Mohan
  • Ina Budhiraja
  • Amit Saxena
  • Perwez Khan
  • S. K. Sachan
Original Paper


To study the role of multilayer amniotic membrane transplantation (AMT) in the treatment of non-healing corneal ulcers. This study included 28 patients with non-healing bacterial corneal ulcers. AMT was performed using the ‘overlay on-inlay’ technique’. The outcome was assessed in terms of best corrected visual acuity (BCVA), corneal re-epithelization, graft/tissue edema and vascularity, graft melting, graft retraction, infection of graft and surface necrosis. The success rate of ulcer healing was 82.1 % (23 patients) 1 month after surgery, 78.5 % (22 patients) after 3 months and 75 % (21 patients) after 6 months. In the early post-operative period, BCVA deteriorated in all patients (perception of light to hand movement) but improved later. In 26 of the 28 patients (92.8 %) graft retraction occurred after 1 month and neovascularization was seen in 17 of the 28 patients (60.7 %). Multilayer AMT using an overlay on-inlay graft in non-healing bacterial corneal ulcers is a good option in terms of ulcer healing and symptomatic improvement.


Amniotic membrane transplantation Non-healing corneal ulcer Bacterial Keratitis 


  1. 1.
    Srinivasan M, Gonzales CA, George C, Cevallos V, Mascarenhas JM, Asokan B et al (1997) Epidemiology and aetiological diagnosis of corneal ulceration in Madurai, South India. Br J Ophthalmol 81:965–971PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Resnikoff S, Pascolini D, Etya’ale D, Kocur I, Pararajasegaram R, Pokharel GP, Mariotti SP (2004) Global data on visual impairment in the year 2002. Bull World Health Organ 82:844–851PubMedCentralPubMedGoogle Scholar
  3. 3.
    Wilson LA (1986) Acute bacterial infection of the eye: bacterial keratitis and endophthalmitis. Trans Ophthalmol Soc UK 105:43–60PubMedGoogle Scholar
  4. 4.
    Pfister RR (1992) Clinical measures to promote corneal epithelial healing. Acta Ophthalmol Suppl 202:73–83PubMedGoogle Scholar
  5. 5.
    Khokhar S, Natung T, Sony P, Sharma N, Agarwal N, Vajpayee RB (2005) Amniotic membrane transplantation in refractory neurotrophic corneal ulcers: a randomized, controlled clinical trial. Cornea 24(6):654–660PubMedCrossRefGoogle Scholar
  6. 6.
    Buxton JN (1981) Therapeutic conjunctival flaps and tarsorrhaphy. Cont Intraocul Lens Med J 7(2):150–152Google Scholar
  7. 7.
    Yildiz EH, Nurozles AB, Ozkan Aksoy N et al (2008) Amniotic membrane transplantation: indications and results. Eur J Ophthalmol 18:685–690PubMedGoogle Scholar
  8. 8.
    Park JH, Jeoung JW, Wee WR, Lee JH, Kim MK, Lee JL (2008) Clinical efficacy of amniotic membrane transplantation in the treatment of various ocular surface diseases. Cont Lens Anterior Eye 31:73–80PubMedCrossRefGoogle Scholar
  9. 9.
    Von vessen-teoyner F, Hesselborth U, Moller DE (2004) Application of sterilized human amnion for reconstruction of the ocular surface. Cell Tissue Bank 5:57–65CrossRefGoogle Scholar
  10. 10.
    Prabhasawat P, Korrirukvongs P, Booranapong W, Vajarodul Y (2000) Application of preserved human amniotic membrane for corneal surface reconstruction. Cell Tissue Bank 1:213–222PubMedCrossRefGoogle Scholar
  11. 11.
    Muraine M, Descarguce G, Frank O, Villeroy F, Toubeu D et al (2001) Amniotic membrane graft in ocular surface disease, prospective study with 31 cases. J Fr Ophtalmol 24(8):798–812PubMedGoogle Scholar
  12. 12.
    Lee S, Tseng SCG (1997) Amniotic membrane transplantation for persistent epithelial defects with ulceration. Am J Ophthalmol 123:303–312PubMedGoogle Scholar
  13. 13.
    Park WC, Tseng SCG (2000) Modulation of acute inflammation and keratocyte death by suturing, blood and amniotic membrane in PRK. Invest Ophthalmol Vis Sci 41:2906–2914PubMedGoogle Scholar
  14. 14.
    Shimazaki J, Yang HY, Tsubota K (1997) Amniotic membrane transplantation for ocular surface reconstruction in patients with chemical and thermal burns. Ophthalmology 104:2068–2076PubMedCrossRefGoogle Scholar
  15. 15.
    Hao Y, Hui-Kang D, Hwang DG et al (2000) Identification of antiangiogenic and antiinflammatory proteins in human amniotic membrane. Cornea 19:348–352PubMedCrossRefGoogle Scholar
  16. 16.
    Shimmura S, Shimazaki J, Ohashi Y et al (2001) Antiinflammatory effects of amniotic membrane transplantation in ocular surface disorders. Cornea 20:408–413PubMedCrossRefGoogle Scholar
  17. 17.
    Meller D, Pires RT, Mack RJ et al (2000) Amniotic membrane transplantation for acute chemical or thermal burns. Ophthalmology 107:980–989PubMedCrossRefGoogle Scholar
  18. 18.
    Rodriguez-Ares MT, Tourino R, Lopez-Valladares MJ, Gude F (2004) Multilayer amniotic membrane transplantation in the treatment of corneal perforations. Cornea 23(6):577–583PubMedCrossRefGoogle Scholar
  19. 19.
    Prabhasawat P, Tesanibul N, Komolsuradej W (2001) Single and multilayer amniotic membrane transplantation for persistent corneal epithelial defect with and without stromal thinning and perforation. Br J Ophthalmol 85:1455–1463PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Sangwan VS, Burman S, Tejwani S, Mahese SP, Murthy R (2007) Amniotic membrane transplantation: a review of current indications in the management of ophthalmic disorders. Ind J Ophthalmol 55:251–260CrossRefGoogle Scholar
  21. 21.
    Gris O, Guell JL, Lopez-Naridad A et al (1999) Application of the amniotic membrane in ocular surface pathology. Ann Transpl 4:82–84Google Scholar
  22. 22.
    Modesti A, Kalebic T, scarpa S, Togo S, Grotendorst G, Lietta LA et al (1984) Type V Collagen in human amnion is a 12 nm fibrillar component of the pericellular interstitium. Eur J Cell Biol 35:246–255PubMedGoogle Scholar
  23. 23.
    Adinolfi M, Akle CA, McColl I (1982) Expression of HLA antigens, beta2 microglobulin and enzymes by human amniotic epithelial cells. Nature 295:325–327PubMedCrossRefGoogle Scholar
  24. 24.
    Akle CA, Adinolfi M, Welsh KI et al (1981) Immunogenicity of human amniotic epithelial cells after transplantation into volunteers. Lancet 2:1003–1005PubMedCrossRefGoogle Scholar
  25. 25.
    Tseng SC, Prabhasawat P, Barton K, Gray T, Meller D (1998) Amniotic membrane transplantation with and without limbal autograft for corneal surface reconstruction in patients with limbal stem cell deficiency. Arch Ophthalmol 116:431–441PubMedCrossRefGoogle Scholar
  26. 26.
    De Souza F, Hofmann-Rummelt C, Kruse FE, Seitz B (2001) Multilayer amniotic membrane transplantation for corneal ulcers not treatable by conventional therapy: a prospective study of the status of cornea and graft during follow-up. Klin Monatsb1 Augenheilkd 218(8):528–534CrossRefGoogle Scholar
  27. 27.
    Hanada K, Shimazaki J, Shimmura S, Tsubota K (2001) Multilayered amniotic membrane transplantation for severe ulceration of the cornea and sclera. Am J Ophthalmol 131(3):324–331PubMedCrossRefGoogle Scholar
  28. 28.
    Kruse FE, Rohrschneider K, Vocker HE (1999) Multilayer amniotic membrane transplantation for reconstruction of deep corneal ulcers. Ophthalmology 106(8):1504–1510PubMedCrossRefGoogle Scholar
  29. 29.
    Dekaris I, Gabric N, Mrauicic Z, Karanian Z, Katersic J, Lazic R, Spoljarie N (2001) Multilayer versus monolayer amniotic membrane transplantation for deep corneal ulcer treatment. Cell Antropol 25(Suppl):23–28Google Scholar
  30. 30.
    Rodriguez-Ares MT, Tourino R, Lopiz-Valladare MJ, Gude F (2004) Multilayer amniotic membrane transplantation in the treatment of corneal perforations. Cornea 23:577–583PubMedCrossRefGoogle Scholar
  31. 31.
    LetKo E, Stech schulte SU, Kenyon KR, Sadeq N et al (2001) Amniotic membrane onlay and overlay grafting for corneal epithelial defects and stromal ulcers. Arch Ophthalmol 119:659–663PubMedCrossRefGoogle Scholar
  32. 32.
    Azuara-Blanco A, Pillai CT, Dua HS (1999) Amniotic membrane transplantation for ocular surface reconstruction. Br J Ophthalmol 83(4):399–402PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Grzetić-Lenac R, Merlak M, Balog T, Babić MB, Dekaris I (2011) Transplantation of amniotic membrane in corneal ulcers and persistent epithelial defects. Coll Antropol 35(Suppl 2):167–169PubMedGoogle Scholar
  34. 34.
    Sheha H, Liang L, Li J, Tseng SC (2009) Sutureless amniotic membrane transplantation for severe bacterial keratitis. Cornea 28(10):1118–1123PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Nubile M, Dua HS, Lanzini M, Ciancaglini M, Calienno R, Said DG, Pocobelli A et al (2011) In vivo analysis of stromal integration of multilayer amniotic membrane transplantation in corneal ulcers. Am J Ophthalmol 151(5):809–822PubMedCrossRefGoogle Scholar
  36. 36.
    Chen JH, Ma DH, Tsai RJ (2002) Amniotic membrane transplantation for pseudomonal keratitis with impending perforation. Chang Gung Med J 25(3):144–152PubMedGoogle Scholar
  37. 37.
    Solomon A, Muller DD, Prabhasawat P, Joen T, Espana EM, Stenlili KP, Tseng SC (2002) Amniotic membrane grafts for non-traumatic corneal perforation descemetoceles and deep ulcers. Ophthalmology 103:694–703CrossRefGoogle Scholar
  38. 38.
    Kheirkhah A, Tabatabaei A, Zavareh MK, Khodabandeh A, Mohammadpour M, Raju VK (2012) A controlled study of amniotic membrane transplantation for acute Pseudomonas keratitis. Can J Ophthalmol 47(3):305–311PubMedCrossRefGoogle Scholar
  39. 39.
    Chen HC, Tan HY, Hsiao CH, Huang SC, Lin KK, Ma DH (2006) Amniotic membrane transplantation for persistent corneal ulcers and perforations in acute fungal keratitis. Cornea 25(5):564–572PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Shalini Mohan
    • 1
  • Ina Budhiraja
    • 1
  • Amit Saxena
    • 1
  • Perwez Khan
    • 1
  • S. K. Sachan
    • 1
  1. 1.Cornea & Glaucoma Services, Department of OphthalmologyGSVM Medical CollegeKanpurIndia

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