Amniotic membrane in ophthalmology: indications and limitations

Abstract

The amniotic membrane remains a useful tool in the treatment of several ophthalmic conditions, especially those related to the ocular surface. However, the 'success' reported in individual case reports and case series is not substantiated in the few published randomised controlled trials. More often than not, it is not as good as existing alternative options and, at best, is as good but with probably an increased cost. The variable outcomes could be related to inter and intra donor variations in the membrane and the depletion or alterations in its constituents subsequent to processing and storage. The membrane thus is a fairly 'non-standardised product' making comparisons of different applications and indications difficult. The potential for 'epidemic' infections, such as HIV, hepatitis B and C, is a serious issue as, in many parts of the world, fresh unquarantined membrane, at times with no tests for the above infectious agents, is being used. The exact mechanism of action of the membrane is not known but the consensus is that it acts as a substrate or scaffold for host cells to populate and thus facilitate healing and repair. The development of a standard 'synthetic membrane' using collagen or polymer matrices impregnated with putative beneficial ingredients, such as growth factors and antimicrobials, is being considered and may prove to be a step in the right direction.

Study of human acellular amniotic membrane loading bone marrow mesenchymal stem cells in repair of articular cartilage defect in rabbits

“…In addition, HAM itself has anti-angiogenic and anti-inflammatory effects. It has been widely used in ophthalmology, cosmetology and repair of burn wounds for a long term (Rahman et al, 2009). 3) HAM can promote the transformation of BMSCs into cartilage (Tan et al, 2011).…”

Autologous Fibrin Membrane Combined With Solid Platelet-Rich Plasma in the Management of Perforated Corneal Ulcers

“…First, it is an uneven biological tissue, with many variables involved in its quality and biological capabilities. 9 Second, it harbors major biological hazards because of the possible presence of viral contaminants and prions. 10 Third, it is not universally available and, in many cases, is expensive.…”

Regeneration of Corneal Epithelium With Dental Pulp Stem Cells Using a Contact Lens Delivery System

“…33 However, donor variation of the amniotic membrane, infection transmission, contradictory actions of proinflammatory cytokines (IL-6 and IL-8), and uncertainty about the exact mechanism of action of the amniotic membrane led researchers to generate a defined synthetic membrane. 34 The use of either amniotic or synthetic membranes requires suturing; therefore, the development of a nonsurgical alternative would be beneficial.…”