Amniotic membrane transplantation in surgical management of ocular surface squamous neoplasias: long-term results

Abstract

Objective To evaluate the long-term efficacy of amniotic membrane transplantation for ocular surface reconstruction in the surgical management of ocular surface squamous neoplasia (OSSN). Methods OSSN in 21 patients (7 female, 14 male patients) was managed with excisional biopsy, cryotherapy, corneal epitheliectomy with absolute alcohol application when the cornea is involved, lamellar sclerectomy and adjunctional absolute alcohol application to the base when episclera is involved, and ocular surface reconstruction with cryopreserved amniotic membrane transplantation. Tumor control and complications were evaluated. Results The mean age of the patients was 62. 42 ± 20.9 (range, 16-84). The average diameter of the base of the tumors was 13.1 ± 4.8 (range, 9-21) mm and complete removal was achieved in all cases as revealed histopathologically. Ocular surface healing was achieved in all cases. At the postoperative period, limbal stem cell deficiency in three eyes and mild symblepharon in one eye were detected. In a mean follow-up of 30.95 ± 18.8 (range, 13-75) months, no recurrence was detected. Conclusion For large or multifocal conjunctival tumors, the reconstruction of ocular surface and fornix is challenging. The amniotic-membrane use to repair conjunctival defects larger than 10 mm is a safe and effective technique with minimal complications allowing surgeons to make large enough excisions.

Updates in Ocular Surface Tumor Diagnostics

“…However, for large and diffuse lesions without clear margins, even intended excisional biopsy may not remove the entire lesion. Also, for large or recurrent lesions, excisional biopsies lead to increased risks of limbal stem cell deficiency, symblepharon, and scarring 10,11 . Lastly, as medical options for treatment of OSSN increase in number and become more utilized, non-invasive methods of diagnosis become more important 12 .…”

Cryopreserved Ultra-Thick Human Amniotic Membrane for Conjunctival Surface Reconstruction After Excision of Conjunctival Tumors

“…3,12,14 Cryopreserved AM is the most commonly used form because it preserves the intact basement membrane and contains a higher amount of soluble, wound-healing modulating factors. 7,15,16 Studies show that it facilitated complete epithelial healing, with good or excellent cosmesis, in patients with ocular surface neoplasia.…”

“…1,2 The AM promotes epithelialization; inhibits fibrosis; has antiscarring, antiangiogenic, and antiinflammatory properties; and has a high hydraulic conductivity. [3][4][5][6] It has been used in ophthalmology for corneal disorders and conjunctival reconstructions after the excision of pterygium, tumors, and symblepharon lysis. [4][5][6][7][8][9] AM is commercially available in airdried or cryopreserved forms.…”

Amniotic membrane allografts: development and clinical utility in ophthalmology

“…Amniotic membrane has been used for various other conjunctival defects and abnormalities. Palamar et al 41 recently reported on their experience using amniotic membrane for ocular surface reconstruction following the excision of ocular surface squamous neoplasia and found it to be effective for large conjunctival defects. Yang et al 42 recently reported that patients with severe chronic atopic keratoconjunctivitis could benefit from surgical management using amniotic membrane.…”