Abstract
This study evaluated the clinical efficacy of amniotic membrane transplantation with or without limbal graft in the management of ocular surface disease (11 primary pterygia, nine recurrent pterygia, one limbal choristoma, three chemical injuries, and one cryotherapy to the limbal region). In addition, eight patients underwent the temporary amniotic membrane anchoring flap surgery for two chronic stromal herpetic keratitis, two non-healing corneal ulcer, two corneal perforation, and two chemical burns. The average duration of follow-up ranged from 3 to 40 months (mean 24.3 ± 10.4 months). In pterygium, the recurrence rate was 18% (2/11) after amniotic membrane transplantation. In recurrent pterygium and pseudopterygium, amniotic membrane transplantation with a small piece of limbal autografi resulted in an improved ocular surface without recurrence in all of the cases, and symblepharon and ocular motility were significantly improved postoperatively. Complications included submembrane hemorrhage (12%, 3/25) and early detachment or dissolution of the membrane (4%, 1/25). No major complications such as infection and rejection were encountered. In selected cases, a temporary amniotic membrane flap anchored onto the corneal surface led to rapid epithelial wound healing in unresponsive ulcerative keratitis. These results indicate that extracellular matrix components provide a good cell basement membrane interaction that is critical for cytoskeletal changes or differentiation. Furthermore, the amniotic membrane can also protect the ocular surface from being exposed to the unwanted inflammatory cytokines, derived from tears, and subconjunctival inflammatory cells. These procedures are thought to be clinically useful for ocular surface reconstruction.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
S.C.G. Tseng, Chen, J.J.Y., Huang, A.J.W., et al, Classification of conjunctival surgeries for corneal disease based on stem cell concept. Ophthalmol Clin. North Am. 3:595 (1990).
S.C.G. Tseng, Concept and application of limbal stem cells. Eye 3:141 (1989).
S.C.G. Tseng, Conjunctival grafting for corneal disease. In, Duane’s Clinical Ophthalmology, W. Tasman, and Jaeger, E.A., eds., (1994).
R.J.F. Tsai, Sun, T-T., and Tseng, S.C.G., Comparison of limbal and conjunctival autografi transplantation in corneal surface reconstruction in rabbits. Ophthalmol. 97:446 (1990).
K.R. Keynon, and Tseng, S.C.G., Limbal autografi transplantation for ocular surface disorder. Ophthalmol. 96:709 (1989).
R.A. Copeland, and Char, D.H., Limbal autografi reconstruction after conjunctival squamous cell carcinoma. Am.J. Ophthalmol. 110:412 (1990).
C. Jonkins, Tuft, S., Lin, C., and Buckley, R., Limbal transplantation in the management of chronic con-tact-lens-associated epitheliopathy. Eye 7:629 (1993).
K.H. Kenyon, Wagoner, M.D., and Hettinger, M.E., Conjunctival autografi transplantation for advanced and recurrent pterygium. Ophthalmology 92:1461 (1985).
J.M. Koch, Mellin K.B, and Waubke, T.N., The pterygium, autologous conjunctiva-limbus transplantation as treatment. Ophthalmology 89(2): 143 (1992).
J.C. Kim, and Tseng, S.C.G., Transplantation of preserved human amniotic membrane for surface reconstruction in severely damaged rabbit corneas. Cornea 14:473 (1995).
R.A. Thoft, Conjunctival transplantation. Arch. Ophthalmol. 95:1425 (1977).
W.K. Herman, Doughman, D.J., and Lindstrom, R.L., Conjunctival autografi transplantation for unilateral ocular surface disease. Ophthalmology 90:1121 (1983).
K.H. Kenyon, Wagoner, M.D., and Hettinger, M.E., Conjunctival autografi transplantation for advanced and recurrent pterygium. Ophthalmology 92:1461 (1985).
T. Gundersen, Conjunctival flap in the treatment of corneal disease with reference to a new technique of application. Arch. Ophthalmol. 60:880 (1958).
J.D. Telford, and Trelford-Sauder, M., The amnion in surgery, past and present. Am. J. Obstet. Gynecol. 134:833 (1979).
A. DeRoth, Plastic repair of conjunctival defects with fetal membrane. Arch. Ophthalmol. 23:522 (1940).
M. Fine, Recurrent pterygium: mucous membrane grafts. In, Symposium on Medical and Surgical Diseases of the Cornea; Transsection of the New Orleans Academy of Ophthalmology C.V. Mosby, St. Louis (1980).
J. Friend, and Thoft, R.A., Functional competence of regenerating ocular surface epithelium. Invest. Opthalmol. Vis. Sci. 17:135 (1979).
R.A. Thoft, and Friend, J., The X, Y, Z, hypothesis of corneal epithelial maintenance. Invest. Ophthalmol. Vis. Sci. 24:1442 (1983).
A.J.W. Huang, Watson, B.D., Hernan deg, E., and Tseng, S.C.G., Induction of conjunctival transdifferentiation by photothrombotic occlusion of corneal neovascularization. Ophthalmology 95:228 (1988).
S.C.G. Tseng, Hirst, L.W., Faradaghi, M., and Green, W.R., Goblet cell density and vascularization during conjunctival transdifferentiation. Invest. Ophthalmol. Vis. Sci. 25:1168 (1984).
S.C.G. Tseng, Hirst, L.W., Faradaghi, M., and Green, W.R., Inhibition of conjunctival transdifferentiation by topical retinoids. Invest. Ophthalmol. Vis. Sci. 28:537 (1987).
S.C.G. Tseng, Faradaghi, M., and Rider, A.A., Conjunctival transdifferentiation induced by systemic vitamin A deficiency. Invest. Ophthalmol. Vis. Sci. 28:1497 (1987).
S.C.G. Tseng, and Faradaghi, M., Reversal of conjunctival transdifferentiation by retinoids. Cornea 7:273 (1988).
A. Schermer, Galvin S., and Sun, T-T., Differentiation-related expression of a major 64K corneal keratin in vivo and in culture suggests limbal location of corneal epithelial stem cells. J. Cell. Biol. 103:49 (1986).
W.Y.W. Chen, Mui, M-M, Kay, WW-Y, et al., Conjunctival epithelial cells do not transdifferentiate in organotipic cultures: expression of K12 keratin is restricted to corneal epithelium. Curr. Eye. Res. 13:765 (1994).
S. Kinoshita, Nishida, K., Kiritoshi, A., et al., Keratin expression in the conjunctival epithelium can be greatly influenced by the external environment. Invest. Ophthalmol. Vis. Sci. 33(S): 1176 (1992).
A. Kiritoshi, Nishida, K., Ohashi, Y., et al., 64 kd keratin expression in normal conjunctival epithelium. Invst. Ophthalmol. Vis. Sci. 34(S):1490 (1993).
Z-G. Wei, Wu, R-L., Lavuka, R.M., and Sun, T-T., In vitro growth and differentiation of rabbit bulbar, for-nix, and palpebrai conjunctival epithelia. Implications on conjunctival epithelial transdifferentiation and stemcell. Invest. Ophthalmol Vis. Sci. 34:1814 (1993).
M. Rodriguez, Ben-Zvi, A., Krachmer, J., et al., Suprabasal expression of a 64 kilodalton keratin in developing human corneal epithelium. Differentiation 34:60 (1987).
M.A. Kurpakus, Stock, E.L., and Jones, J.C.R., The role of the basement membrane in differential expression of keratin proteins in epithelial cells. Dev.Biol. 150:243 (1992).
R,R. Pfister, and Berstein, N., The alkali-burned cornea. I. Epithelial and stromal repair. Exp. Eye Rcs. 23:519 (1976).
D.T. Jones, Munroy, D., Ji, Z., et al., Sjögren’s syndrome: cytokine and Epstein-Barr viral gene expression within the conjunctival epithelium. Invest. Ophthalmol. Vis. Sci. 35:3493 (1994).
N. Shinozaki, Shoda, A., Shimazaki, J., et al., Detection of basic fibroblast growth factor (b-FGF) from amniotic membrane. Invest. Ophthalmol Vis. Sci. 36(S):131 (1995).
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1997 Springer Science+Business Media New York
About this chapter
Cite this chapter
Kim, J.C., Lee, D., Shyn, K.H. (1997). Clinical Uses of Human Amniotic Membrane for Ocular Surface Diseases. In: Lass, J.H. (eds) Advances in Corneal Research. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-5389-2_12
Download citation
DOI: https://doi.org/10.1007/978-1-4615-5389-2_12
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4613-7460-2
Online ISBN: 978-1-4615-5389-2
eBook Packages: Springer Book Archive