Temporary Sutureless Amniotic Membrane Patch for Acute Alkaline Burns

Kheirkhah, Ahmad

doi:10.1001/archopht.126.8.1059

Cited by 107 publications

(91 citation statements)

References 32 publications

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“…This phenomenon was contrasted to the healing pattern reported for eyes with nonsurgical large corneolimbal epithelial defects, where the limbal defect closed before the central corneal defect when AM was not used 32 or when AM was used as a temporary bandage over the entire cornea and limbus for acute chemical burns. 33 In contrast to the healing achieved by sutures, all three patterns by fibrin glue avoided epithelialization under AM, as seen clinically and not with histologic evaluation. Therefore, it is tempting to speculate that the surgical outcome might be promoted by fibrin glue, which allows cells to grow over the basement membrane of AM, taking advantage of its full therapeutic actions.…”

Section: Discussionmentioning

confidence: 79%

“…Recently, we have reported that insertion of a temporary AM patch such as ProKera promotes corneal epithelialization and reduces the ocular surface inflammation in eyes with chemical burns. [33][34][35] Therefore, we also wondered whether providing such a modality during the early healing stage of seven eyes (Table) might have contributed to the successful outcome. Unlike previous studies for partial LSCD, [6][7][8]10 we applied mitomycin C-soaked sponges in the fornix during simultaneous symblepharon lysis and fornix reconstruction in seven eyes.…”

Section: Discussionmentioning

confidence: 99%

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Sutureless Amniotic Membrane Transplantation for Partial Limbal Stem Cell Deficiency

Kheirkhah

Casas

Raju

et al. 2008

American Journal of Ophthalmology

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PURPOSE-To evaluate the results of sutureless amniotic membrane (AM) transplantation using fibrin glue for reconstructing corneal surfaces with partial limbal stem cell deficiency (LSCD). DESIGN-Retrospective noncomparative interventional case series.METHODS-Eleven eyes of nine patients that had LSCD with 120 degrees to almost 360 degrees of limbal involvement underwent superficial keratectomy to remove the conjunctivalized pannus followed by AM transplantation using fibrin glue. Additional sutureless AM patch (ProKera; BioTissue, Inc, Miami, Florida, USA) was used in seven patients, and mitomycin C was applied on the cornea in four eyes and during fornix reconstruction in seven eyes. The surgery was repeated in three eyes for residual pannus.RESULTS-During a mean follow-up of 14.2 ± 7.7 months (range, six to 26 months), all eyes maintained a smooth and stable corneal epithelial surface without recurrent erosion or persistent epithelial defect, and showed less stromal cloudiness and vascularization. Best-corrected visual acuity improved in nine eyes (81.8%). Corneal epithelialization proceeded by epithelial growth over AM (n = 4), accompanied by dissolution of AM (n = 4) or a combination of both (n = 3). No complication was noted regarding initial or repeated uses of fibrin glue.CONCLUSION-AM transplantation using fibrin glue appears to be a safe and effective method of restoring a stable corneal epithelium for cases with partial LSCD. This approach avoids the need of transplanting limbal epithelial stem cells. THE MAINTENANCE OF A HEALTHY CORNEAL EPITHElium under both normal and traumatic conditions is provided by a unique subpopulation of stem cells located at the limbus. 1,2 When limbal epithelial stem cells are destroyed and/or their supporting stromal environment becomes dysfunctional, a pathological state known as limbal stem cell deficiency (LSCD) develops (for review; see Reference 3 ). LSCD carries the cytologic evidence of conjunctivalization of the corneal surface by a goblet cell-containing conjunctival epithelium. 4 Pathologically, limbal-deficient corneas exhibit destruction of the basement membrane, superficial neovascularization, chronic inflammation, scarring, and poor epithelial integrity (for reviews; see References 3 and 5 ). Clinically, LSCD is a major cause of corneal blindness unable to be corrected by traditional corneal transplantation alone.For eyes inflicted with partial LSCD, where a part of the limbus is damaged, the corneal surface can be reconstructed by debridement of conjunctivalized epithelium with 6-8 or without 9 transplantation of amniotic membrane (AM). Several studies have shown that in eyes with partial LSCD, AM promotes expansion of remaining limbal epithelial stem cells. [6][7][8]10 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript these studies, sutures were used to secure AM to the cornea following the removal of conjunctivalized pannus from the corneal surface. Recent findings suggest that epithelialization may occur both over and unde...

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Sutureless Amniotic Membrane Transplantation for Partial Limbal Stem Cell Deficiency

Kheirkhah

Casas

Raju

et al. 2008

American Journal of Ophthalmology

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“…This allows the underlying epithelial defect to heal and maintain fornix architecture. Keirkhah et al 26 recently reported the use of a sutureless AM patch in acute severe alkali injuries (ProKera s ; Bio-Tissue Inc., Miami, Florida). For some time, we have used an inexpensive and easily accessible method for this purpose, namely an AM sutured around a conformer, with great success.…”

Section: Symblepharonmentioning

confidence: 99%

Amniotic membrane in ophthalmology: indications and limitations

Rahman

Said

Maharajan

et al. 2009

Eye

151

108

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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.

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“…The use of an amniotic membrane onlay has been shown to relieve pain, encourage epithelialisation, and reduce vascularisation and scarring. 22 However, if there is marked inflammation, a membrane may rapidly melt, and a number of repeat surgeries may be necessary. The rapid onset of stromal melting may indicate a secondary infection that should be investigated and treated, 23 Acute lamellar or penetrating keratoplasty may then be required if there is corneal perforation.…”

Section: Intermediate (Postacute) Managementmentioning

confidence: 99%